Sinus headaches 

Diagnosis  

Determining the cause of headaches can be challenging, often involving inquiries from the healthcare provider about your symptoms and a thorough physical examination. Additionally, your provider might opt for imaging tests as part of the assessment process to aid in identifying the underlying cause for your headaches, which includes:  

• Computed Tomography (CT) scan. In a CT scan, pictures from an X–ray machine that rotates around the body are combined to create cross–sectional images of the brain and skull (including the sinuses).  
• Magnetic Resonance Imaging (MRI). A magnetic field and radio waves are employed in magnetic resonance imaging (MRI) to provide cross–sectional images of the brain’s structural components.  

Treatment

Treatment for migraines and chronic or recurring headaches often involves prescription medication, which can be taken daily to minimize or prevent headaches, or taken as soon as a headache begins to stop it from worsening. 

Your doctor might suggest the following to treat these headaches:  

• Over–the–counter pain medications. Migraines and various headache types can be managed using over–the–counter medications like acetaminophen, naproxen sodium, and ibuprofen. 
• Anti–nausea medications. Since migraines often come with nausea, with or without vomiting, anti–nausea medication is suitable and typically used in conjunction with other treatments. Commonly prescribed medications include those like chlorpromazine, metoclopramide, and prochlorperazine. 
• Triptans. During migraine attacks, many individuals turn to triptans for pain relief. These medications function by blocking pain pathways in the brain and causing blood vessel constriction. However, they should be avoided if there’s a history of heart disease or stroke. Triptans are available in various forms like tablets, nasal sprays, and injections. Additionally, a combination of sumatriptan and naproxen sodium in a single tablet has demonstrated enhanced efficacy in alleviating migraine symptoms compared to using each medication separately. 
• Ergots.  Combination drugs containing ergotamine and caffeine are less effective compared to triptans for treating migraines. Ergots are most effective for individuals with migraines lasting over 72 hours. However, they can worsen nausea, vomiting, and other side effects, potentially leading to medication overuse headaches. Dihydroergotamine, an ergot derivative, is more efficient with fewer side effects than ergotamine. It’s available as a nasal spray and injections and is less likely to cause medication–overuse headaches. Ergots, including dihydroergotamine, cause blood vessel constriction and should be avoided if there’s a history of heart disease or stroke.  
• CGRP antagonists. Specifically oral calcitonin gene–related peptide (CGRP) receptor antagonists, have received approval for managing acute migraines in adults, whether accompanied by aura or not. 
• CGRP monoclonal antibodies. Erenumab–aooe, fremanezumab–vfrm, galcanezumab–gnlm, and eptinezumab–jjmr are more recent medications authorized by the Food and Drug Administration for migraine treatment. These drugs are administered through injections on a monthly or quarterly basis. 
• Glucocorticoids. Like dexamethasone, can be combined with other medications to enhance pain relief. However, due to the potential for steroid toxicity, the use of glucocorticoids should not be frequent.     
• Lasmiditan. This recently developed oral tablet has gained approval for managing migraines with or without aura. It functions by inhibiting pain pathways, akin to triptan medications, yet it doesn’t seem to cause blood vessel constriction.