Nosebleed – the medical term is epistaxis – rarely occurs during a migraine attack. However, a handful of patients have reported this to me during my 23 years of practice. Migraines may cause epistaxis in one or more ways. First, a sudden increase in blood pressure could be associated with acute pain. Second, you may have nasal congestion with widening of the tiny blood vessels called capillaries within the nose. If your nosebleeds are brief and only occur during migraines, I would not be concerned. Otherwise, I would see an otolaryngolgist for an examination to look for a structural lesion that could be the source of the bleeding. Q2. I have had chronic headaches for the last three years. My doctor finally found a septal spur. Do you think that could be the cause of my headaches? I do, but my insurance company denied the operation. What is your opinion? A septal spur (a bend or outgrowth of the bone and cartilage that divides the right and left cavities of the nose) may trigger migraine headaches. Such headaches are usually located over one of the sinus cavities, on the same side as the spur. Usually, the patient has a history of seasonal allergies, recurrent sinus infections, and/or nasal congestion. Headaches triggered by contact between the septum and one of the turbinates (sinus tissue) are referred to as “contact point headaches.” However, contact points are often seen on a sinus CT scan in a patient whose headaches are on the opposite side, or who doesn’t even have a history of headaches. There are reports of headaches improving following removal of a contact point. Before recommending septal surgery to a patient, I recommend that he/she be seen by an ear, nose and throat physician during at least three suspected contact point headaches. The doctor applies a decongestant and a local anesthetic to the nasal septum, adjacent to the contact point. If the headache intensity lessens by at least 50 percent within five minutes of administration of the two agents at every visit, then I think the patient is likely to benefit from surgery. Moreover, proving the association and the relief may make the insurance coverage more likely. But you have to see the doctor while you have the headache pain. Q3. I am 37 years old and have been having daily headaches since a sinus infection in October 2004. I’ve been diagnosed with migraines, tension headaches and a combination of both. I’ve been on seven different headaches medications since they began. I’ve noticed over the last winter that I do not have headaches when I am on antibiotics. My neurologist says it’s just a coincidence. What is your opinion and do you have any other suggestions for what I can try? I have a number of patients who report the same history: chronic daily or near-daily headaches following a sinus infection months or years earlier. Like you, some of them report temporary improvement or resolution of the headaches while taking an antibiotic for an infection. I think you should be evaluated for chronic sinusitis, especially of the sphenoid sinus (the sinus cavity that is farthest back in the head), with a CT scan of the sinuses. Chronic sinusitis may be difficult to diagnose, so an ear, nose and throat (ENT) evaluation should be considered. I also suggest that you ask your neurologist to refer you to a headache specialist, if he/she does not specialize in headaches. A referral to an ENT physician should also be considered if you have a history of chronic allergy and/or sinus symptoms. Chronic sinusitis can be treated with an extended course of antibiotics, oral decongestants, painkillers and sometimes even surgery. Q4. Should I be concerned about a nosebleed accompanying a migraine? Not necessarily. Nosebleeds can sometimes accompany a migraine headache; why this happens isn’t known. But they usually go away on their own and aren’t anything to worry about, unless the epistaxis(nosebleed) lasts for more than a few minutes, seems to result in a lot of blood loss, or occurs with nearly every migraine and your migraines occur several times per month. Learn more in the Everyday Health Headache and Migraine Center.
