Q. I feel like every afternoon around the same time I experience a burning sensation that begins at the right side of my forehead and crosses to the left side. It surrounds my eyebrows and eyelids. It’s not dissimilar from the sensation of sunburn, but the best way to describe it is tightness in the forehead. It can cause my eyelids to burn and swell and exacerbate my dry-eye problem. At times, I experience a sharp dagger-like pain in my right eye and under the brow bone. The whole thing lasts about three hours. A CT scan of my sinuses was clear. Is this description consistent with cluster headaches?

More than 37 million Americans suffer from migraine. This vascular headache is most commonly experienced between the ages of 15 and 55, and 70% to 80% of sufferers have a family history of migraine. Less than half of all migraine sufferers have received a diagnosis of migraine from their healthcare provider. Migraine is often misdiagnosed as sinus headache or tension-type headache. Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.

Researchers from two hospitals in Italy have been studying what they call "airplane headache" (AH) and recommend that the disorder be included in the next update to the International Headache Society classification. Such a move, the authors say, would bring more studies and better understanding of AH and how it might be prevented. In recent years, these authors have followed 75 people who contacted them about experiencing AH and have developed a profile of the painful disorder.

Q: I have been having a mild-to-moderate throbbing pain above my ear that comes and goes. My eye bothers me, too. Two ibuprofens seem to lessen the throbbing. I do drink a lot of coffee with caffeine and am not sure if that’s a factor. I am only worried because I have never had headaches before. How can I be sure I don’t have a tumor or bleeding in the brain?

Although a 2008 NHF web survey determined that 23% of respondents claim to suffer from sinus headache, research concludes that that “stuffy nose and dull head pain” should may actually be migraine or another form of vascular headache. A large majority of sinus headache sufferers actually experience some form of a vascular headache. The enlargement of blood vessels typically causes vascular headaches, which include migraines, cluster headaches, and toxic headaches.  Typically, the sufferer feels throbbing head pain that is intensified by physical exertion.

This is part of our Case Studies in Headache Series which can be found in the National Headache Foundation's newsletter, the NHF Head Lines. By Philip Bain, M.D. Wilkinson Medical Clinic Hartland, Wisconsin THE CASE C.B. is a 45-year-old female who presented to her new primary care physician recently to establish care. She has been quite healthy except for recurrent sinus headaches. These headaches began approximately 15 years ago and, at least initially, nearly always responded to antibiotics. She had an agreement with her previous healthcare provider that when her sinuses acted up, he would call in a prescription for a course of antibiotics. After taking the antibiotics for 2-3 days, her headaches would almost always go away. The headaches were located over the forehead and cheeks. She rarely noted fevers or chills, but would often have clear nasal discharge and nasal congestion. Her stomach was also upset, which she attributed to post nasal drainage. The episodes would occur 8-9 times per year and, at times, were so bad that she would have to miss work because of the pain. Because of her frequent episodes, she had been referred to an ENT physician. He ordered a CT scan of her sinuses which showed mild inflammation of the lining of the sinuses as well as a deviated septum. C.B. underwent two separate surgeries to correct the septal deviation and to improve the drainage from the sinus passages. The headaches improved after the first surgery, but then gradually returned to their previous pattern. C.B. saw numerous other healthcare providers over the years for these sinus headaches and even tried such therapies as acupuncture, chiropractic, cranial sacral therapy, and a TMJ splint. She presented to her new primary care physician frustrated and resigned to suffer from these recurrent headaches. This case represents a classic example of a patient with a long history of headaches, incorrectly attributed to recurrent sinus infections. The likelier cause of her headaches is migraine without aura. This is an important presentation of migraine to recognize because it is too often misdiagnosed, but very treatable. It can be very difficult for patients to accept that their headaches are migraine and not sinus-related. This can lead to years of inappropriate treatment and needless suffering.

Allergy Headaches Symptoms: Generalized headache; nasal congestion; watery eyes Precipitating Factors: Seasonal allergens, such as pollen, molds. Allergies to food are not usually a factor. Treatment: Antihistamine medication; topical, nasal cortisone related sprays; or desensitization injections Prevention: None Learn more about the relationship between allergies and headaches. Aneurysm Symptoms: May mimic frequent migraine...

Responses to questions presented by the headache specialists are not intended to be professional consultations. Final decisions as to treatment should rest with the individual’s healthcare provider. Q. I am somewhat appalled by the sweeping conclusion to “not nap” made in the article “Changing Sleep Habits May Lead to Fewer Headaches” by Dr. Calhoun, published in the May/June 2007 issue of NHF Head Lines. Being a migraine sufferer for about 35 years, I find that my best defense is to take a nap. Not only are naps restorative, but they actually act as a migraine prophylaxis in my ability to have a two-part day, meaning daytime activity, a nap, and then the nighttime activity. This lowers the risk of a migraine on that day and also on the following day. I don’t believe that I veer from the norm since everybody I know of any age or gender seems to require a nap in order to not get a migraine. Even a friend’s son who is in his late 20s and is a gym teacher and personal trainer requires a nap. I agree that napping does affect the night’s sleep, but I think that lighter sleep is a key to acting as a preventive. I find that migraines usually develop at the end stages of a deep night’s sleep. If I go to bed without a nap and with exhaustion and have a deeper sleep, I am far more likely to wake up with a migraine. If I take a nap and am not as exhausted when I retire, and perhaps don’t sleep as deeply, I wake up feeling far more refreshed, and at least I have a better chance of not having a migraine and being able to function.