Benadryl for migraine headaches

Migraine Headaches

The National Headache Foundation estimates that 29.5 million Americans suffer from migraines. 40% of sufferers experience one or more attack per month. Each migraine can last from four hours to three days, and rarely, even longer.

The exact causes of migraine headaches are unknown, but the headaches are linked to changes in the brain as well as to genetic causes. People with migraines may inherit the tendency to be affected by certain triggers, such as fatigue, bright lights, and weather changes. Additional possible triggers include:

  • Emotional stress
  • Sensitivity to specific chemicals and preservatives in food. (Aged cheeses; alcoholic beverages; processed meats; monosodium glutamate)
    • Possible food triggers:
      • Alcohol
      • Avocados
      • Bananas
      • Broad bean pods
      • Caffeine
      • Canned figs
      • Cheeses (aged)
      • Chicken livers
      • Chocolate
      • Citrus fruits
      • Cured meats
      • Fermented, pickled, or marinated foods
      • Fresh bread, coffee cake, doughnuts
      • Herring
      • MSG (monosodium glutamate)
      • Nuts, peanut butter
      • Onions
      • Pizza
      • Pork
      • Sour cream
      • Vinegar
      • Yogurt
      • Caffeine may precipitate, or in some cases relieve migraines.
  • Changing weather conditions, storm fronts, barometric pressure changes, strong winds, altitude changes.
  • Menstrual periods
  • Tension
  • Excessive fatigue
  • Skipping meals
  • Changes in normal sleep patterns

The symptoms of migraines can be variable, but often they begin as a dull ache and develop into a throbbing pain. The pain is usually aggravated by activity. Associated symptoms of migraine headaches include:

  • Sensitivity to light, noise and odors
  • Nausea and vomiting, stomach upset, abdominal pain
  • Loss of appetite
  • Sensations of being very warm or cold
  • Fatigue
  • Dizziness
  • Blurred vision

There are several types of migraine headaches, including:

  • Migraine with aura (Classic Migraine): This type is usually preceded by an aura. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). Auras can also be changes in smell, taste, or other sensation.
  • Migraine without aura (Common Migraine): This type accounts for 80% of migraine headaches. There is no aura before a common migraine.
  • Status migrainosus: This is the term used to describe a long lasting migraine that does not go away on its own.

Mild to moderate migraines can often be handled by:

  • Applying a cold compress to the area of pain.
  • Resting with pillows comfortably supporting the head and neck.
  • Drinking a moderate amount of caffeine.
  • Trying certain over the counter medications. (Ibuprofen, acetaminophen, sometimes with caffeine)
  • Resting in a room with little or no sensory stimulation (light, sound, odors).
  • Withdrawing from stressful surroundings.
  • Sleeping.

When these measures do not help, migraine headaches may be eased with a prescription medication. Migraines can be treated in two ways: with abortive therapy (when the headache has already begun), or with preventive therapy (to keep them from occurring).

The goal of abortive therapy is to prevent a migraine attack or stop it once it starts. The sooner the medication is taken after the initial symptoms occur, the more effective it will be. Some abortive therapies include:

  • Imitrex (pills, nasal spray, or injection) or
  • Treximet (a combination of Imitrex and naproxen)
  • Zomig (pill or nasal spray)
  • Relpax
  • Amerge
  • Maxalt (pill or disintegrating tablet)
  • Frova
  • Axert

Preventive treatments are considered if migraine headaches occur more than once a week. These drugs are meant to lessen the frequency and severity of the migraine attacks. Preventive treatments include:

  • Medications used to treat high blood pressure, such as Inderal and Covera.
  • Antidepressants, such as Elavil and Pamelor.
  • Antiseizure medications such as neurontin, Depakote and Topamax.
  • Some antihistamines and anti-allergy drugs, including Benadryl and Periactin.

For more information on migraine headaches:

Until one morning last February, when it didn’t. I woke with a migraine, took my pill. Slept, woke still sick. The next day, the same — a blurry dissociation, a pain between my eyes. The next day, again, the day after that too. My migraine was stuck. And it would be — for the next seven months.


Migraines have an unwieldy medical history. A sketch of a rudimentary vessel constrictor was found on papyrus scrolls dated 1550 B.C., buried alongside a mummy in Thebes — healers, apparently, would wrap a strip of linen printed with the name of Egyptian healing gods (along with, inexplicably, a clay crocodile with grain in its jaws) tightly to patient’s head. A circa A.D. 300 mural found on the wall of a Roman villa depicts a handmaiden applying a poultice of honey and opium to her master’s head. Other early treatments were less gentle: Practitioners in the Medieval era were known to insert garlic into incisions in patients’ temples, drawings from Italian medieval manuscripts show doctors drilling holes into patients’ skulls to release the “bad spirits” making them sick. In 1609, the French explorer Samuel de Champlain was said to have treated a particularly painful migraine by scraping the teeth of a gar fish across his temple, hard enough to draw blood.

The medicine has progressed since the time of tombs and linen headbands, drilled skulls and evil spirits, but not as much as you might think. Almost every drug used to treat migraine between 1550 B.C. and now has been repurposed, treatments built for people with conditions that are not ours: Botox, anticonvulsant drugs, antidepressants, beta blockers — drugs whose efficacy was not intended, but stumbled upon. The triptan that kept my migraines at bay for most of my life was created in 1992, the year I was born. It was the first and, until recently, the last class of drugs ever created specifically for migraine sufferers.

This strange dearth of specialized treatment is mostly thanks to a long-standing lack of research into what happens in a person’s body during a migraine attack, says neurologist Dr. Peter Goadsby, the director of the UCSF Headache Center. Which, in turn, is due to the fact that migraines were entirely invisible until the advancement of imaging technology. “You can’t see them, which made them terribly difficult to quantify and to get people to take seriously,” says Goadsby. “You know, if you turn up to work with an ankle in a cast everyone offers you a seat and treats you like a queen for the day. If you turn up with a migraine they’ll shout at you like they did yesterday, turn the lights up, and wonder why you’re moaning.”

And as for the preponderance of repurposed treatments: Well, they’re basically just a product of how many people suffer migraines. “Some 18 percent of the population get migraines,” he says. “And naturally migraineurs get other problems. A sharp doctor sees that propranolol is helping their patient’s blood pressure and their headaches, so they do a clinical trial and soon propranolol is given out to migraineurs whose blood pressure is fine.” It’s a difficult conversation, Goadsby says, when he has to explain to his patients that there isn’t a migraine preventative made specifically for migraine prevention. “I have to say: You don’t have epilepsy, but I’m giving you an anti-epilepsy drug. Or you don’t have depression, but I’m giving you a strong antidepressant. They’re forced to choose what side effects they’d prefer from a rag-tag collection of things that are meant for something else: a tricyclic antidepressant, which might make them tired and give them dry mouth, a seizure medication called Topamax which might make it so they can barely remember what their name is. It’s a real drag.”

Targeted medication isn’t the only thing that has lagged: though migraine is the world’s sixth-most debilitating condition, only three hours are spent on headaches during four years of medical school. Less than one percent of NIH’s annual budget is dedicated to headache research — $13 million, some 50 cents per sufferer.A 2009 study that compared migraine funding to ten other chronic illnesses with similar “disease burden” — the impact of a health problem as measured by financial cost, mortality, and morbidity — showed that funding should exceed some $103 million per year.


Those first three days, I stayed home from work, sleeping fitfully through the driving pain in my forehead. When I woke, a terrible dissociation set me back from the world: from the wintery sunsets outside the window of my childhood bedroom, from the leaking bag of frozen peas I tucked under my neck to numb the ache at the base of my skull. A blinking light intermittently stole my vision, my speech grew halting and strange. Sleeping exhausted me, talking exhausted me, reading a book was impossible — I couldn’t concentrate, my mind felt unbearably slow. When the migraine still hadn’t broken after four days, I booked an emergency appointment with my doctor. He listened to my symptoms, looked at me with removed sympathy, and prescribed me a steroid pack. The appointment lasted less than 15 minutes. After six days of steroids, I was queasy and bloated, the migraine undiminished. I went back, choked with a panic I fought to temper. Another five-minute appointment. Another round of steroids. Another six days. I called. With a trace of irritation, my doctor advised me to go to the ER to get a drip of migraine drugs that can only be administered by IV. “We’d do it in our office,” he told me. “But there’s only one nurse who’s trained and she’s booked for a month.”

I went to the ER, the pain in my forehead tripling under the fluorescent lights, and received, intravenously, a cocktail of migraine drugs. A baby girl squalled beside me, only a thin curtain separating our beds, as her mother played music on her phone and ate a sickeningly fragrant container of pad Thai. When that treatment didn’t work, he sent me back. “It often doesn’t work for three or four treatments,” he wrote to me, a fact he hadn’t mentioned until that moment. Twelve more hours in the emergency room, then 24 — the migraine didn’t improve, and my forehead was so tight with pressure I was sure relief could only come by way of some gory cranial explosion. A fourth trip and the nurse couldn’t get the IV into my arm; my veins were bruised and shrank back every time she tried to insert the needle. Back into my doctor’s office, where his nurse administered nerve-blocking shots into the swollen veins at the back of my skull and I sobbed miserably onto the linoleum floor.

Two weeks later, another round of nerve-blocking shots and a five-day course of nasal spray containing DHE, a potent vessel constrictor from the 1920s. It didn’t work; my doctor suggested another round. More, more, more medication. With each failed treatment I called my doctor to ask him what was next —what the plan was, where I would go from here. He responded curtly: Take this drug, I don’t know if there’s anything else we can do at this point, please don’t call on the weekends. I am never going to get better, I wanted to scream from the depths of my increasingly unfamiliar body. My doctor suggested a spinal tap if I still had a headache in a week.

It’s difficult not to see migraine as a woman’s disease, when migraines so disproportionately affect women. One out of four women will experience migraine in their lives, three times as many as men. And every woman who has suffered migraine has a story of dismissal — of being told their headaches were a symptom of anxiety or neuroticism, of not having a boyfriend, of being unable to handle the stresses of their everyday life. This year, my mother was prescribed Klonopin for her migraines, a female friend prescribed a strong sedative.
So it’s difficult, too, not to see the lack of research into migraine treatment as a symptom of who most commonly inherits this disease.

Of course, this is not unique to migraine treatment. Women are less likely to be treated properly in general, according to Maya Dusenbery, whose book Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, comes out this March. “Women wait sixty-five minutes to men’s forty-nine before getting treatment for abdominal pain in the emergency room,” she writes in her book. “Young women are seven times more likely to be sent home from the hospital in the middle of having a heart attack. Women face long delays, often years long, to get diagnosed even with diseases that are quite common in women. And they experience longer diagnostic delays in comparison to men for nearly everything, from brain tumors to rare genetic disorders.” She attributes these findings, largely, to the persistent archetype of the hysterical woman —which is especially present, she said, in how people view women with headaches.

“In the last couple of decades, people have stopped viewing migraines as a psychosomatic condition — the research has advanced and they’ve accepted it as the neurobiological disease it is,” she says. “But still, even with all that progress, it’s treated as minor affliction. Still the stereotypes associated with it — that migraine sufferers are hypersensitive, whiny women — persist.” Dr. Alexander Mauskop, the founder of the New York Headache Center, confirms this assessment. “The lack of research throughout the 20th century — it’s because people, then and now, underestimated migraines. They thought that it was a disease of neurotic women.”

Four months after my migraine hit, I went to a new doctor. A woman, who suffers migraines herself, whose mother suffered migraines so painful she’d have to stay in her room for whole days at a time. That first appointment lasted an hour — she walked me slowly through my entire migraine history: a lifetime of minutiae filled, it suddenly seemed, with clues for treatment. And then we developed a plan. She told me to only to take as-needed medication twice a week, when my headaches were particularly painful, so as to avoid rebounds. She focused on prevention, instead — she put me on Effexor, an anti-anxiety medication that has some demonstrated anti-migraine properties. She suggested I cut out sugar from my diet. She told me to take daily magnesium, and vitamin E the week before my period. And she told me that if all that didn’t work, then we’d go to the next thing. Not right away. “There’s so much we haven’t tried,” she said. “And the nice thing about migraines is that they usually go away.”

When the pills didn’t decrease my headaches substantially after a month, she recommended Botox, a (yes: stumbled-upon) FDA-approved treatment for chronic migraine that entails 35 shots of the toxin to the head, shoulders, and neck every three months. The injections work by relaxing your scalp muscles — and possibly by reducing the firing of the sensory nerves in the brain. The first round didn’t help. The second did. And finally, after some seven months of near-daily headaches, I experienced relief. My headaches dropped from 25 days a month to 15. A month later, to 10. Then to 5. Sometimes fewer.

This year, the second-ever treatment created exclusively for migraine — the first-ever migraine preventative — will be released. It’s a single shot composed of a specially created antibody that targets a neurotransmitter called CGRP, which has been shown to spike in patients in the midst of a migraine. The injections modulate patients’ CGRP levels to prevent attacks from happening, instead of treating them once they’ve already begun. The trials have been overwhelmingly successful — in one, patients with an average of eight monthly migraines found their episodes reduced by almost four migraine-days a month by their fourth month of receiving the injections. The trial, it should be said, was aided by a powerful placebo affect: Patients who received the placebo had a reduction of some 1.7 migraine days a month. But still, the results are meaningful. “Because of the lack of research, because of the lack of technology,” says Goadsby, “we lacked a specific target to focus on. We couldn’t say, well, migraines cause X and therefore we will block X and migraine will get better. And that’s what the CGRP is. If you block it, in people who respond, you’ll block their migraines. We never had that before.” And, he says, “Soon we’ll be able to say to our patients: You have migraine, you have a lot of migraine, we’re going to give you something to prevent migraine. And what it’s called is a migraine preventative.”

The very release of the drug does feel complicated — enraging that it’s coming so late, a relief that it’s coming at all. But mostly: It’s nice to feel heard. My doctor told me a story a couple of weeks ago. I laid on the table squeezing pressure balls as she tucked my hair behind my ear to inject a shot of Botox into my temple. “A patient came in recently,” she said. “I asked if she had a history of migraine. She said no, but then she thought about it a little more and said — well, my grandmother used to have to go lay down during almost every family event. But we just thought she was antisocial.”

Benadryl Allergy & Sinus Headache

Generic Name: acetaminophen, diphenhydramine, and phenylephrine (a SEET a MIN oh fen, DYE fen HYE dra meen, and FEN il EFF rin)
Brand Name: Benadryl Allergy & Sinus Headache, Delsym Cough Plus Cold Night Time, Mucinex Fast-Max Night Time Cold and Flu, Robitussin Nighttime Multi-Symptom Cold, Sudafed PE Severe Cold, Theraflu Severe Cold & Cough Nighttime, Theraflu Warming Flu & Sore Throat, Theraflu Warming Sinus & Cold

Medically reviewed by on Feb 18, 2019 – Written by Cerner Multum

  • Overview
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  • Dosage
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  • Pregnancy
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What is Benadryl Allergy & Sinus Headache?

Acetaminophen is a pain reliever and fever reducer.

Diphenhydramine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.

Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).

Benadryl Allergy & Sinus Headache is a combination medicine used to treat headache, fever, body aches, runny or stuffy nose, sneezing, itching, watery eyes, and sinus congestion caused by allergies, the common cold, or the flu.

Benadryl Allergy & Sinus Headache may also be used for purposes not listed in this medication guide.

Important Information

Do not use this medicine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Do not take more of this medication than is recommended. An overdose of acetaminophen can damage your liver or cause death. Call your doctor at once if you have nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of your skin or eyes).

In rare cases, acetaminophen may cause a severe skin reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling.

Before taking this medicine

You should not use this medication if you are allergic to acetaminophen, diphenhydramine, or phenylephrine.

Do not use this medicine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Ask a doctor or pharmacist if it is safe for you to take this medicine if you have other medical conditions, especially:

  • asthma or COPD, cough with mucus, or cough caused by smoking, emphysema, or chronic bronchitis;

  • a blockage in your stomach or intestines;

  • liver disease, alcoholism, or if you drink more than 3 alcoholic beverages per day;

  • kidney disease;

  • high blood pressure, heart disease, coronary artery disease, or recent heart attack;

  • enlarged prostate or urination problems;

  • glaucoma;

  • diabetes;

  • overactive thyroid;

  • pheochromocytoma (an adrenal gland tumor); or

  • if you take potassium (Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, Polycitra, Urocit-K).

It is not known whether Benadryl Allergy & Sinus Headache will harm an unborn baby. Do not use this medicine without your doctor’s advice if you are pregnant.

This medication may pass into breast milk and may harm a nursing baby. Antihistamines and decongestants may also slow breast milk production. Do not use this medicine without your doctor’s advice if you are breast-feeding a baby.

How should I take Benadryl Allergy & Sinus Headache?

Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. This medicine is usually taken only for a short time until your symptoms clear up.

Do not take more of this medication than is recommended. An overdose of acetaminophen can damage your liver or cause death.

Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children.

Measure liquid medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Dissolve one packet of the powder in at least 4 ounces of water. Stir this mixture and drink all of it right away.

Do not take for longer than 7 days in a row. Stop taking the medicine and call your doctor if you still have a fever after 3 days of use, you still have pain after 7 days (or 5 days if treating a child), if your symptoms get worse, or if you have a skin rash, ongoing headache, or any redness or swelling.

If you need surgery or medical tests, tell the surgeon or doctor ahead of time if you have taken this medicine within the past few days.

Store at room temperature away from moisture and heat. Do not allow liquid medicine to freeze.

What happens if I miss a dose?

Since Benadryl Allergy & Sinus Headache is taken when needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1 800 222 1222. An overdose of acetaminophen can be fatal.

The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.

What should I avoid while taking Benadryl Allergy & Sinus Headache?

Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen, and can increase certain side effects of diphenhydramine.

This medicine may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Benadryl Allergy & Sinus Headache side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.

Stop using this medicine and call your doctor at once if you have:

  • chest pain, rapid pulse, fast or uneven heart rate;

  • confusion, hallucinations, severe nervousness;

  • tremor, seizure (convulsions);

  • easy bruising or bleeding, unusual weakness;

  • little or no urinating;

  • nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of your skin or eyes); or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, chest pain, shortness of breath, uneven heartbeats, seizure).

Common side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Benadryl Allergy & Sinus Headache?

Ask a doctor or pharmacist before using this medicine if you are also using any other drugs, including prescription and over-the-counter medicines, vitamins, and herbal products. Some medicines can cause unwanted or dangerous effects when used together. Not all possible interactions are listed in this medication guide.

Taking this medicine with other drugs that make you sleepy or slow your breathing can worsen these effects. Ask your doctor before taking Benadryl Allergy & Sinus Headache with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 2.05.

Medical Disclaimer

More about Benadryl Allergy Plus Sinus Headache (acetaminophen / diphenhydramine / phenylephrine)

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Related treatment guides

  • Cold Symptoms

Allergy Headaches


The sinus cavities are hollow air spaces with openings into the nose to allow the exchange of air and mucus. They are located inside each cheekbone, behind the eyes, behind the bridge of the nose and in the forehead. Secretions from the sinus cavities normally drain into the nose.

Sinus headaches and pain occur when the sinuses are swollen and their openings into the nasal passages are obstructed, stopping normal drainage and causing pressure to build up.

Often the pain is localized over the affected sinus, perhaps causing facial pain rather than a headache. For example, if the maxillary sinus in the cheeks is obstructed, your cheeks may be tender to the touch and pain may radiate to your jaw and teeth. Obstruction in other sinuses can cause pain on the top of your head or elsewhere. Sinus pain can be dull to intense; it often begins in the morning and becomes less intense after you move from lying flat to sitting or standing in an upright position.

Similar pain can also be caused by severe nasal congestion, particularly if you have a deviated septum or a septal “spur” from a previous nasal injury. Such “headaches” or facial pain can involve one side only.

Don’t let sinus headaches hold you back from the things you love. Find expert care with an allergist.

Management and Treatment

The first approach in managing sinus headaches is to avoid the allergens that trigger them.

Outdoor exposure:

  • Stay indoors as much as possible when common triggers, such as high pollen counts, are at their peak, usually during the midmorning and early evening, and when wind is blowing pollens around.
  • Avoid using window fans that can draw pollens and molds into the house.
  • Wear glasses or sunglasses when outdoors to minimize the amount of pollen getting into your eyes, as this can cause your sinuses to flare up.

Indoor exposure:

  • Keep windows closed, and use air conditioning in your car and home. Air conditioning units should be kept clean.
  • Reduce exposure to dust mites, especially in the bedroom. Use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs.
  • To limit exposure to mold, keep the humidity in your home low (between 30 and 50 percent) and clean your bathrooms, kitchen and basement regularly. Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with detergent and a 5 percent bleach solution as directed by an allergist.
  • Clean floors with a damp rag or mop, rather than dry-dusting or sweeping.

Exposure to pets:

  • Wash your hands immediately after petting any animals. Wash your clothes after visiting friends with pets.
  • If you are allergic to a household pet, keep it out of your home as much as possible. If the pet must be inside, keep it out of the bedroom so you are not directly exposed to animal allergens while you sleep.
  • Close the air ducts to your bedroom if you have forced-air or central heating or cooling. Replace carpeting with hardwood, tile or linoleum, all of which are easier to keep dander-free. Placing an air purifier in the bedroom may also help.

Many allergens that trigger sinus headaches are airborne, so you can’t always avoid them. The best way to manage your allergy headaches is to see an allergist. Another common cause of sinus headaches is allergic rhinitis (hay fever). Both prescription and nonprescription (over-the-counter or OTC) oral medications — antihistamines, decongestants and corticosteroids — are used to treat hay fever.

Another common cause of sinus headaches is allergic rhinitis (hay fever). Both prescription and nonprescription (over-the-counter, or OTC) oral medications — antihistamines, decongestants and corticosteroids — are used to treat it.

  • Antihistamines. These block the effects of histamine, a chemical produced by the body in response to allergens. Histamine is responsible for the symptoms of allergic rhinitis, including sneezing, itchy eyes and an itchy, runny nose. First-generation OTC antihistamines available in the United States can cause drowsiness, and regularly taking them can lead to a feeling of constant sluggishness, affecting learning, memory and performance. Newer antihistamines — such as Claritin (loratadine) and Zyrtec (cetirizine), both OTC, and Clarinex (desloratadine), Allegra (fexofenadine) and Xyzal (levocetirizine), available by prescription — are designed to minimize drowsiness while still blocking the effects of histamine.
  • Oral and nasal decongestants. Found in many OTC and prescription medications, these may be the treatment of choice for the nasal congestion that causes a sinus headache. Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue.
  • Intranasal corticosteroids. This is the single most effective drug class for treating allergic rhinitis. These medications can significantly reduce nasal congestion as well as sneezing, itching and a runny nose.

Other treatments and medications include:

  • Allergy shots (immunotherapy). Allergen immunotherapy, or allergy shots, may be recommended for people who don’t respond well to treatment with medications, experience side effects from medications, have allergen exposure that is unavoidable or desire a more permanent solution to their allergy problem.
  • Nasal cromolyn. Nasal cromolyn is a nasal spray that blocks the body’s release of allergy-causing substances. Nasal cromolyn can help to prevent allergic nasal reactions if taken prior to an allergen exposure. It does not work in all patients.
  • Pain relievers. Mild OTC pain relievers such as Tylenol (acetaminophen) or Advil (ibuprofen) may provide short-term relief for sinus headache pain.

At-home treatments

  • Apply a warm, moist washcloth to your face several times a day.
  • Drink plenty of fluids to thin the mucus.
  • Inhale steam two to four times per day (for example, while sitting in the bathroom with the shower running).
  • Spray the nose with nasal saline several times per day.
  • Use a neti pot to flush the sinuses.

This page was reviewed for accuracy 4/17/2018.

How Do You Break a Migraine That Won’t Stop?

A frustrated, worried reader asked us: “I’ve had this same migraine for two weeks. This has never happened to me before. How do I break this?”

This problem can happen to anyone with migraine. When our typical medicines stop working and migraine keeps going beyond the usual 4-72 hours, we may be experiencing a complication of migraine called Status Migrainosus. In A Neurologist’s Guide to Status Migrainosus Therapy in the Emergency Room, Drs. Gelfand and Goadsby state, “It must be stated at the outset that an ED visit for migraine represents a failure of appropriate outpatient management, and modifications in the patient’s rescue plan need to be made to avoid such visits in the future.”

The missing link

One of the common failures in acute treatment of migraine is the lack of rescue treatments. A rescue treatment is different than the typical medicine you use to abort a migraine. Most often, patients are prescribed a triptan, NSAID, or ergot-derivative to abort a migraine attack. These are acute medications that can be used at the first sign of symptoms. When these treatments fail, it is appropriate to use a rescue treatment. Most commonly, rescue treatments are strong NSAIDS like toradol or difenolac, but can also be diphenhydramine, anti-emetics (like Zofran, Compazine, or Phenergan), or even opioids. A rescue treatment should be a medicine that you can administer at home when your abortives fail. The goal of a rescue treatment is to prevent you from having to seek treatment at the ER.

If you do not have a rescue treatment available for home use when abortives fail, then please talk to your doctor. This is an essential part of migraine management that is often overlooked. For decades, I would ask my doctor what to do if my triptan failed. His only response was to visit the ER. It wasn’t until I pushed back, insisting that a visit to the ER for a cocktail shot of Toradol, Benadryl, and Phenergan was unnecessarily expensive and wasteful did he agree to prescribe these medicines to me for home use. Starting in 2013, I began using IM injections of Toradol with a Phenergan suppository as my rescue treatment. Thanks to this, I have been able to avoid the ER ever since. Instead, a few times each year, I am able to treat unresponsive attacks at home, saving me thousands of dollars and avoiding the unnecessary use of the ER.

Getting Immediate Help

Unfortunately, all of this good advice doesn’t help you stop a prolonged attack in progress. If you’ve already exhausted all of your home treatments, and the attack is still going strong after 72 hours, you do need to call your doctor. In most cases he or she will recommend you go to the emergency room for evaluation and treatment. Most likely, the problem is Status Migrainosus which can be stopped in the ER or with a brief inpatient stay.

Common medicines used to treat Status Migrainosus

IV Fluids
When migraine is prolonged, there is an increased risk of dehydration which can make treating Status Migrainosus more difficult. In most ERs, the first step in treating Status Migrainosus is IV fluids to correct any dehydration that may be present, especially if the patient has been vomiting.

If someone presents at the ER with migraine and has not been prescribed a triptan, the first option is usually to administer a subcutaneous injection of sumatriptan.

Toradol (ketorolac) is most often used in the ER to treat Status Migrainosus. There are numerous studies to support its effectiveness, which can be as high as 80%. The typical dose is 60 mg via IV. When toradol fails or is not available, 75 mg of diclofenac is another option.

Chlorpromazine (Thorazine), Procholorperazine (Compazine), and Promethazine (Phenergan) are commonly used to treat Status Migrainosus when first-line NSAIDs fail. They all have the risk of causing temporary dystonia or akathisia. Diphenhydramine is often used as a pretreatment to prevent these side effects. Chlorpromazine (Thorazine) is an older medicine with a long history of effectively breaking status migrainosus. Prochloroperazine (Compazine) is more commonly used in children. The typical dose is 10 mg IV or IM or 25 mg suppository. Promethazine has fallen out of common use due to the risk of soft tissue injury. All phenothiazines have the secondary benefit of antiemetic properties and may also be used as rescue treatments at home.

Both droperidol (Inapsine) and haloperidol (Haldol) have been used when other measures have failed. They are not typically first-line options because both can cause uncontrollable limb movements, restlessness, and agitation (akathisia).

Dihydroergotamine (DHE)
A typical dose of DHE is 0.5 to 1 mg IV, repeated up to a total of 3 mg over 24 hours. Nausea is a common side effect, so patients are often pretreated with an antiemetic such as Zofran, Phenergan, or Compazine. It has a proven efficacy rate of 60% within 1 hour of administration. Unfortunately, there has been a shortage of DHE in many locations, which is also contributing to rising costs. Outside of major headache centers, many doctors are reluctant to use it.

Although commonly used, there is little evidence that corticosteroids are effective at treating Status Migrainosus. In fact, a meta-analysis of existing studies showed that migraine often recurred 24-72 hours after discharge when corticosteroids were used.

Sodium Valproate
Also known as Depakote, a typical dose ranges from 300 to 1200 mg IV. It is contraindicated during pregnancy, liver disease, and kidney disease.

While generally avoided when treating migraine, opioids are occasionally used to break intractable pain. They are not as effective as other treatments. When used long term, they can contribute to the development of chronic migraine and medication overuse headache. They may be considered for short-term use during pregnancy when many migraine-specific treatments are contraindicated.

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