If you have migraines and you also have frequent sneezing and congestion, you may be surprised to know that there’s a potential connection between your head pain and your sniffles. Migraines are more common in people who have allergies and/or rhinitis. Rhinitis is a health condition that causes nasal symptoms like sneezing and congestion, though experts aren’t exactly sure how migraines and nasal symptoms are connected.
Rhinitis, particularly allergic rhinitis/allergies, and migraines have quite a few things in common.
- Are common conditions
- Can significantly decrease your productivity and your quality of life
- Cause fatigue, head pain, brain fog, and difficulty sleeping
- Affect the same areas of the body, i.e., eyes, forehead, nose, and face
- Have similar triggers, such as weather changes, strong smells, allergens, and smoke
- Get worse during peak allergy seasons
Symptoms that allergies, rhinitis, and migraine have in common include:
- Nasal congestion
- Watery eyes
- Runny nose
- Pain or pressure behind the eyes
- Feeling of heaviness in your head
How and when you experience symptoms of rhinitis, however, depends on the type that you have.
Rhinitis is a medical condition that causes inflammation in the lining of your nasal cavity, resulting in nasal symptoms. Almost everyone experiences it at some point, but some people deal with it seasonally or chronically.
There are many types of rhinitis. The most common ones include:
- Allergic rhinitis: Also known as hay fever, this type of rhinitis occurs when your immune system reacts to certain airborne substances the same way it would to a virus or bacteria, causing an allergic reaction. Typical triggers include tree grass, pollen, mold, dust mites, and pets; allergic rhinitis may be seasonal or perennial (year-round).
- Non-allergic rhinitis: Nasal congestion and postnasal drip are the main symptoms of this type of rhinitis, which is not related to allergies. Typical triggers include certain medications, smoke, weather changes, and strong fragrances, like car exhaust, cleaning products, or perfume. There are different forms of non-allergic rhinitis.
- Mixed rhinitis: This is the most common type of rhinitis in adults and includes both allergic and non-allergic rhinitis. However, it’s usually diagnosed simply as allergic rhinitis since there isn’t a diagnostic code in the United States for mixed rhinitis.
Multiple studies have found that migraines are more common in people who have rhinitis and/or allergies. For example, a 2014 study in Cephalalgia examined the potential link between migraines and rhinitis. In the study, of the 6,000 questionnaire respondents who reported having migraines, 67% also had rhinitis.
The questionnaire also asked migraine suffers how many migraines they had per month, as well as how much their migraines affected them (as assessed by the Migraine Disability Assessment Scale (MIDAS)).
Results showed that migraine attacks were 14% to 28% more frequent when the migraine sufferer also suffered from rhinitis. People who had mixed rhinitis (both allergic and non-allergic) were the most likely to experience an increased frequency of migraines and have more disabling migraines than those without rhinitis.
A 2016 review of existing studies on allergic rhinitis and migraine also found data that supports the theory that people who have both conditions tend to have more severe migraines more frequently.
The Role of Sinusitis
Since sinusitis (inflammation of your sinus cavities) can cause headaches, and because rhinitis often causes symptoms of sinusitis, it’s important to understand the role of sinusitis in this whole picture as well. Rhinitis is linked intimately with sinusitis for the following reasons:
- The nose and sinuses are essentially one passageway.
- Having rhinitis often leads to developing sinusitis.
- Having sinusitis commonly causes nasal symptoms.
The term rhinosinusitis is used interchangeably with sinusitis, but some experts prefer the term rhinosinusitis to the term sinusitis since sinusitis rarely occurs without rhinitis.
It’s important to note that, often, a headache in a patient with rhinitis is misdiagnosed as a sinus headache when it’s really a migraine. In fact, the majority of sinus headaches are actually migraines. Unfortunately, many of these migraines are still treated as sinus infections, so treatment may not be effective in relieving your head pain.
Theories About the Link
The scientific basis for the relationship between rhinitis, allergies, and migraine is not clear. Do migraines trigger or worsen symptoms of rhinitis and/or allergies or vice versa? No one really knows, but here are a few of the theories.
Trigeminal Nerve Activation
One hypothesis involves the trigeminal nerve, a large cranial nerve with endings in the face that supply sensation and some motor or movement function. Rhinitis-associated inflammation and swelling in the nose, as well as allergens, may stimulate trigeminal nerve endings, causing pain signals to be sent to the brain, which may then trigger a migraine.
Other experts suggest that the release of chemicals from local immune system/inflammatory cells in allergic rhinitis may trigger migraine development in certain people. For example, when you have an allergic reaction, your body releases histamine, which can cause the blood vessels in your brain to constrict, resulting in a migraine or worsening a current migraine.
These conditions involve inflammatory processes, which may help explain why they often occur together.
Overall, more studies are needed to better understand this link.
Because rhinitis and/or allergies can make migraines worse, treating them may decrease the number of migraines you have and improve your quality of life, and should be your main area of focus. You may want to consider seeing an allergist or an ear, nose, and throat doctor (otolaryngologist, or ENT) who can do tests to find out exactly what you’re allergic to.
For allergic rhinitis, treatments like over-the-counter nasal sprays and antihistamines might be all you need. But if your allergies are more severe, you may need prescription medications like nasal steroids. Allergy shots might also be a good option for you.
Treating non-allergic rhinitis usually involves prescription nasal sprays. Your doctor may also recommend over-the-counter decongestants and saline nasal sprays.
Avoidance of Triggers
Both rhinitis and migraine involve your body’s response to triggers, so avoiding whatever sets off each condition as much as possible can make a difference. If you’re not sure what your migraine triggers are, try keeping a migraine diary for a few weeks to see if you notice a link between your migraines and sleep patterns, certain foods, weather changes, or stress.