“I see people with allergies who think they have sinus headaches when in reality, many of them meet the criteria for migraine,” says Dr. Strauss. If you’re living with both conditions, the one-two punch of allergies and migraine can keep you indoors (often in a dark room) and away from friends and activities for weeks or even months, depending on the season. Find out how allergies may be triggering or worsening migraine and what the experts advise about seeking diagnosis and treatment. RELATED: Is It a Migraine Attack or a Sinus Headache?
People With Migraine Are More Likely to Have Allergies
Migraine and allergies are both very common conditions, and it’s not at all unusual for people to have both, according to Katherine Hamilton, MD, an assistant professor of clinical neurology and a headache specialist at Penn Medicine in Philadelphia. “It’s also been shown in studies that people with migraine are more likely to have allergies, and people with allergies are more likely to have migraine, though we don’t understand exactly why that link exists. It may potentially be related to genetic factors,” says Dr. Hamilton. A study published in the Pakistan Journal of Medical Sciences found that migraine frequency in people with allergic rhinitis was four times higher than in those without allergic rhinitis. Of those with migraine, 95 percent experienced migraine without aura and 5 percent had migraine with aura.
Persistent Headache More Typical of Migraine Than Allergies
Trying to determine what is headache due to migraine versus what is a headache due to allergies is a common issue, says Hamilton. “We know that a lot of people can have a misdiagnosis of sinus headaches or headaches from allergies, when in fact their headaches are from migraine.” Hamilton points to a study published in JAMA Internal Medicine that found that 88 percent of people with a history of sinus headaches actually had a migraine-type headache. “A large percentage of people were misdiagnosed,” she says. “The fact is, headache is not a very common symptom, in and of itself, of seasonal allergies or allergic rhinitis. It’s much more common to have symptoms such as nasal congestion, like a stuffy nose or runny nose, and eye watering,” says Hamilton. If you do have a headache that persists, it might not be just allergies, she says. “That might be an indication that there’s also migraine going on. Typically, headache can be due a sinus infection or viral or bacterial infection, but it’s rare to have a significant headache from just allergy symptoms,” says Hamilton.
Migraine and ‘Sinus Headache’ Have Overlapping Symptoms
Part of the reason for confusion is because oftentimes, migraine-related headaches mimic what people typically think of as sinus headaches, she explains. “You can have pain over the sinuses and over the face with both types of headache. With migraine, there can also be symptoms that are similar to allergy symptoms, like a stuffy or runny nose and eye tearing, and that overlap can be why patients are misdiagnosed,” says Hamilton. However, there are some key symptoms of migraine that you won’t find in other types of headaches, which can include nausea, vomiting, light sensitivity, and sound sensitivity, according to the American Migraine Foundation. Some people with migraine have a visual aura that includes bright spots, lights, or colors prior to the onset of an attack, which wouldn’t happen in a tension-type or sinus headache. RELATED: 11 Answers to Your Questions About Light Sensitivity and Eye Pain in Migraine
Allergies Could Trigger Migraine Attack in a Few Different Ways
It makes sense that allergies could trigger an attack in people who are predisposed to migraine, says Hamilton. “If you’re having a lot of allergic symptoms, and you’re having a lot of inflammation in the body, that could make you more prone to migraine attacks in general,” she says. Some experts believe that the histamine release that happens during allergic reactions can potentially also play a role in migraine, she says. “There are potential mechanisms that could explain an increased propensity for migraine when you’re having seasonal allergies,” says Hamilton. Histamine is a chemical found in some cells that can be released when a person is allergic to something, and it causes many of the symptoms of allergies. Histamine release may be involved in triggering a headache, specifically migraine, according an article published in March 2019 in The Journal of Headache and Pain. Allergies may indirectly contribute to migraine by disrupting sleep, says Strauss. “If you’re very uncomfortable from all this congestion and postnasal drip, that could even be a trigger for headache,” she says. RELATED: Sleep Tips for People With Migraine
Even if You Have Allergies, Frequent Headaches May Indicate Migraine
Hamilton suggests talking with your primary care doctor if you’re having frequent headaches with allergy symptoms. “That might mean that your allergies are actually triggering migraines or contributing,” she says. In that situation it might be useful to try migraine medications — both as-needed, or abortive, medications and potentially preventive medications, she adds. “If it is a migraine, treating the attack with decongestants, antihistamines, and other allergy medicines typically won’t be as effective as a targeted migraine treatment,” says Strauss. “A good rule of thumb is that if you’re not getting complete relief of your headaches from over-the-counter medications, or if the headaches are becoming more frequent or frequent enough that you’re having to take an over-the-counter medication several times a week, you should definitely seek a doctor’s care,” says Hamilton.
Treating Allergies Could Help With Migraine
There are certainly scenarios where treating allergies may help headaches, says Strauss. “But what we want to avoid is spending years cycling through tons of allergy medicines if someone is having severe headaches. There are other medications we’d want to try,” she says. “If you have migraine attacks that seem to really be triggered by certain changes in the environment — for example, higher pollen — or if there is really a lot of nasal congestion or runny nose, then I think it may be worth exploring the role of allergies,” says Hamilton. Strauss suggests keeping a yearly calendar year to see if there are certain months or seasons when migraine attacks become a problem. “ This can tip you off if it’s related to something in the environment, and you could talk with your doctor. It may help to take preventive migraine medications or allergy medicine during those months,” she says.
OTC Medications for Allergies and Migraine Come With Potential Risks
If the symptoms of allergies and migraine are fairly mild, they could both be treated with just over-the-counter medications, says Hamilton. “I would caution people who are self-treating who think their headaches are from allergies. They may take a lot of allergy medication, and certain ones like Sudafed (pseudoephedrine) can potentially cause a worsening headache if you take it frequently,” she says. Pain relivers such as aspirin, acetaminophen, NSAIDS, decongestants, and combination medicines that contain caffeine, aspirin, and acetaminophen or butalbital can all contribute to medication overuse headache (MOH), according to the American Migraine Foundation. MOH is defined as a headache occurring on 15 or more days per month in a person with a preexisting primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication, according to the International Headache Society. RELATED: 10 Things You Need to Know About Medication-Overuse Headache
You May Need Specialists to Treat Your Migraine and Allergies
It’s important to be aware that migraine and allergies are commonly present in the same person and both issues need to be addressed, says Hamilton. “It might take potentially seeing different doctors — both an allergist and a neurologist — and trying different medications for both conditions. In some cases, you may not get complete relief until you address both issues,” she says.
