Q&A: Seasonal allergy symptom treatment may also improve migraine outcomes

Key takeaways:

• Allergy symptoms such as nasal congestion can irritate the trigeminal nerve and trigger migraine attacks.
• Patients who suffer from migraines should be screened for allergies, which could then be treated.

As allergies emerge each spring, so do migraines. The American Migraine Foundation says that 37% of people with allergies also have migraines, compared with 5% of people who do not have allergies, in an association that increases with age.

However, the organization notes, allergens are not responsible for triggering migraines. Instead, the symptoms caused by the allergens then cause the migraines. So, treating the symptoms of allergy can potentially improve outcomes for patients with migraine too.

Healio spoke with Shae Datta, MD, a neurologist with NYU Langone Health and codirector of NYU Langone’s Concussion Center, to find out more about this connection between allergy symptoms and migraine attacks.

Healio: Could you describe some of the common triggers of migraine?

Datta: There are varying triggers for the migraine process, varying from person to person, that can include:

• sudden changes in weather or environment;
• sinus pressure or allergies;
• stress;
• overexertion;
• loud or sudden noises;
• motion sickness;
• low blood sugar;
• too much or not enough sleep;
• strong odors or fumes;
• emotion;
• skipped meals;
• tobacco;
• depression;
• anxiety;
• head trauma;
• hormonal changes; and
• bright or flashing lights.

Healio: Could you provide some detail about how allergens trigger migraines?

Shae Datta

Datta: Seasonal allergens can inflame the sinuses and trigger migraines because of the proximity of the eyes and sinuses to the nerves that get triggered in migraines. The pain of a migraine is caused by the overactivation of nerve fibers within the wall of brain blood vessels traveling inside the meninges, or the three layers of membranes protecting the brain and spinal cord.

Healio: Are there any allergens that are particularly troublesome in triggering migraine attacks?

Datta: A sinus headache is caused by swelling in the sinuses from inflammation. This inflammation blocks the openings, preventing drainage and causing pressure to build up. Common seasonal and year-round allergens such as pollen, mold and pet dander can cause your body’s immune system to react with a sinus headache, even if you have no other allergy symptoms.

Healio: How can providers and patients tell the difference between sinus headache and migraine attack:

Datta: The best way to confirm it is a migraine attack is to see if there is a throbbing pain on the one side of the head, indicating a migraine.

Healio: Are there any specific allergy symptoms that are particularly troublesome in triggering migraine attacks?

Datta: First, nasal congestion caused by seasonal allergies can irritate the trigeminal nerve in the nose, which could trigger migraine headaches and associated symptoms.

Next, inflammation can trigger migraine attacks. Allergic reactions happen when exposure to allergens causes runny nose, congestion and postnasal drip. Common allergens include pet hair, dust, grass and pollen, among others. Allergies cause inflammation that could increase migraine frequency.

Finally, there is parasympathetic nervous system disruption. Allergies cause the parasympathetic nervous system, which regulates the body’s digestion and rest, to throw the body off balance, disturbing sleep. Dehydration, hunger, fatigue and stress are also migraine triggers for some people.

Healio: How can allergists address symptoms specific to migraine?

Datta: The key is to treat the allergies and get sufficient control over them and, hopefully, that will resolve the migraines. It is important to avoid dehydration and inflammation in the sinuses.

Healio: Are there any treatments that are particularly effective in dealing with both allergy and migraine?

Datta: If you’re suffering from sinus headaches or migraines, allergy testing can help you determine whether they are caused by allergies. An allergist will take a detailed medical history and review your symptoms before doing allergy testing. Treating your underlying allergies and avoiding your triggers is the most important way to prevent allergy-related migraines. A migraine specialist may further give you as needed or preventive medications for migraines that persist beyond addressing underlying issues.

Healio: What role does collaboration with other providers have in treating migraine related to allergies?

Datta: The collaboration with ENT, allergists and migraine specialists is a close one due to overlapping and confounding factors. Effective collaboration would include sharing of records and evaluating for allergens and other migraine risk factors by the neurologists. If they are in the same system and share medical records, it is very helpful for continuity of care and prevention.

Healio: Is there any specific advice that providers can offer patients to help prevent these symptoms?

Datta: It would be important for allergy sufferers to have an allergen-free atmosphere at home and to have a HEPA filter. Proper medication and hydration techniques could prevent the triggering of allergy symptoms that may lead to a migraine. While antihistamines, decongestants and immunotherapy might help, there are other ways to avoid allergies, including:

• wearing a mask while outside and while cleaning the house;
• closing the windows in your house and vehicle;
• spending more time indoors on windy days;
• washing bedding and deep cleaning rugs and furniture regularly;
• using an air purifier;
• changing air filters every 3 months;
• using a dehumidifier to prevent more growth; and
• relaxing in a dark, quiet room.

Healio: Do you have anything else you would like to add?

Datta: It is a myth that over-the-counter remedies are better than what a migraine specialist may give you for your migraines, as they can often worsen the symptoms and just temporarily mask them.

Reference:

• Allergies and migraine: How do they affect you? https://americanmigrainefoundation.org/resource-library/allergies-and-migraine-how-do-they-affect-you/. Published July 28, 2022. Accessed April 17, 2023.