Headache With Ear Pain
Ear problems – A dull, aching pressure on the side of the head, face, or jaw may indicate an ear infection or a vestibular migraine, Symptoms that usually accompany ear-related problems include:
pain in the ear, jaw, or templedizziness or vertigo trouble hearing tinnitus, or a ringing in the earsvision problemsfluid discharge from the ear
Is ear pain normal with migraine?
Discussion – In the current literature, migraine pathophysiology and treatment data have been dominantly produced by neurologists as it was thought to be a purely neurologic disease, but with the light shone from other perspectives, we know that migraine can present with many different symptoms other than headache involving other specialties including otolaryngology,
- It is conceivable for an otolaryngologist presented with migrainous otalgia, to easily miss the diagnosis and attribute the symptoms to a primary ear or sinus condition,
- Many studies documenting common causes for referred otalgia in the clinical setting do not examine migraine as a potential cause,
For example, in a study of origins of referred otalgia in a tertiary setting, 150 out of 450 patients had referred otalgia in which roughly 5% of patients (7 out of 150) had an unknown origin for their otalgia and none was attributed to migraines. Unfortunately, there are no standardized clinical criteria for diagnosing migraine associated otalgia and no easily discernable physical exam or radiologic findings that make the diagnosis of other causes of referred otalgia more straight-forward.
- Headache and dizziness are the only two typical migraine symptoms in the head and neck that are defined by clinical criteria (the IHS for headache and Nehauser’s for vestibular migraine),
- Various other head and neck manifestations can occur outside of the acute headache but are believed to result from the same pathophysiology process of migraines,
These symptoms include sinus pressure, nasal congestion, and runny nose, Referred migraine pain is common throughout the head and neck, and as many as 80% of patients with a “sinus” headache are diagnosed as fulfilling IHS migraine criteria at time of screening,
- Otologic symptoms of migraine include ear fullness and pressure, ear pain, sound sensitivity, and tinnitus,
- Sabra et al.
- Described ear pain and fullness as the most common non-dizzy migrainous ear symptoms.
- 50 patients (46.3%) presented for an atypical chief complaint out of which 34.2% were ear symptoms (mostly ear pain and fullness) and 14.8% nasal symptoms (mostly nasal congestion and sinus pressure) and 2.7% had an ear and nose atypical chief complaint.” According to Schulz et al.
, 38.2% of patients with positive migraine screening also reported unusual ear sensitivity and 38% experienced ear pressure. Teixido et al. found that 77% of their patients presenting with otalgia had a concordant headache history. All these data show the importance of the study of other manifestations of migraine specially in the head and neck area where they are dominantly innervated by trigeminal nerve.
Migrainous otalgia has been previously described only sparingly throughout the literature. One other paper was identified in our literature review that described the experience of treating patients with referred otalgia with traditional migraine therapy, In agreement with the criteria utilized by Teixido et al.
, we define migraine-associated otalgia or migrainous otalgia as otalgia in the setting of: 1) The absence of primary otogenic problem such as otitis media and secondary otalgia associated with non-otogenic problem such as temporomandibular joint dysfunction, or upper aerodigestive disorder.
- AND 1 or more of the following: 1) IHS defined migraine headaches and its subtypes, 2) triggerability by migraine triggers, 3) response to migraine therapy.
- In our tertiary medical center, migrainous otalgia was found in 64 patients out of 208 patients, which was as common as primary otalgia (n=64).
- This high rate of migrainous otalgia can be due to the difficulty of diagnosis of such cases in the community by the primary care providers or general otolaryngologists and the resultant higher rate of referring to higher level of care.
The female to male ratio in our migrainous otalgia group was 4.8:1 which was lower than this ratio in Teixido et al.’s study (12:1) and was greater than the reported 3.3:1 ratio in the adult migraine population, though none of these differences reached a significant level ( χ 2 =1.1431, p -value=0.285 and χ 2 =1.3489, p -value=0.245, respectively).
According to Olsson, “if a patient has migraine, but also has significant cochlear and/or vestibular dysfunction, the migraine syndrome and the peripheral organ must both be treated.” Our study is among the earliest to evaluate treatment outcomes in patients with otalgia and migraine headaches by using migraine therapy.
We propose treatment of migraine associated otalgia with migraine therapy. Our study reveals that otalgia of unknown source in patients with history of migraine can be successfully treated with traditional migraine therapy. Our results echo the findings of Teixido et al.’s study which showed 92% of 26 patients showed more than a 50% reduction in symptom scores with migraine treatment.
- In our study, 87% had significant improvement and 57% of patients experienced complete resolution of their earache after treatment.
- Our sample size was modestly larger at thirty patients even after excluding thirty four patients due to inadequate follow-up.
- Based on our experience, we created a treatment algorithm ( Fig.1 ).
To follow this algorithm, one should be aware of the side effects and contraindications of these medications. For example, propranolol is not recommended for diabetic and asthmatic patients and those with heart failure. As with any retrospective chart review, a limitation is reliance on correct documentation and diagnosis tracking in the electronic medical record.
- Another limitation in our study is patient loss to follow-up.
- We had sixty four patients with unexplained otalgia who met IHS criteria for migraine and only thirty patients who had sufficient follow-up were analyzed for the efficacy of the treatment.
- However, the mean age and gender distribution were not statistically different between the treatment study group and all migrainous otalgia group which made this loss of follow up less detrimental.
The other limitation was having more than one reason for otalgia in some patients where detailed history, physical exam and response to the different treatments were used to determine the main reason of otalgia. Due to markedly common presentation, it is necessary to explore the frequency of stress symptoms, bruxism, and recurrent neck pain in patients with secondary otalgia This project is an introduction to a cohort research project to study the migrainous otalgia and the outcome of the treatment.
Can migraines cause ear and jaw pain?
Can problems with your jaw cause a migraine? – The short answer is: Yes. Migraines and migraine-like headaches can indeed be caused by problems with the jaw, even though you feel pain at the top or side of your head. You may, of course, also have pain in your jaw and/or your ear.
How do I know if I have a migraine or just a headache?
What is a migraine? A Mayo Clinic expert explains – Learning about migraine disorder can be intimidating. Amaal Starling, M.D., a neurologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.
Hi, I’m Dr. Amaal Starling, a neurologist at Mayo Clinic specializing in headache disorders. In this video, we will cover the basics of migraine. What is it? Who gets it, the symptoms, the diagnosis, and most importantly, the treatment. Whether you’re looking for answers for yourself or someone you love, we are here to give you the best information available.
There is a lot of stigma around migraine. That it’s just a headache and that it’s no big deal. But migraine is a genetic neurologic disease. It affects each person differently with a wide range of disease severity. Some have infrequent attacks, but others may have frequent disabling attacks.
Expecting someone to push through or just take your mind off of it is never good advice. Who gets it? Migraine is very common, affecting one in five women, one in 16 men, and even one in 11 children. Migraine attacks are three times more prevalent in women, likely as a result of hormonal differences. Certainly genetic and environmental factors play a role in the development of migraine disease.
And since it is genetic, it is hereditary. Meaning if a parent has migraine, there’s about a 50 percent chance that a child may develop migraine as well. If you have migraine, certain factors can trigger an attack. However, this does not mean that if you get a migraine attack, that it’s their fault, that you should feel any guilt or shame for your symptoms.
- Hormonal changes, specifically fluctuations and estrogen that can occur during menstrual periods, pregnancy and perimenopause can trigger a migraine attack.
- Other known triggers include certain medications, drinking alcohol, especially red wine, drinking too much caffeine, stress.
- Sensory stimulation such as bright lights or strong smells.
Sleep changes, weather changes, skipping meals or even certain foods like aged cheeses and processed foods. What are the symptoms? The most common symptom of migraine is the intense throbbing head pain. This pain can be so severe that it interferes with your day-to-day activities.
It can also be accompanied by nausea and vomiting, as well as sensitivity to light and sound. However, a migraine can look very different from one person to another. Some people may get prodrome symptoms, the beginning of a migraine attack. These can be subtle warnings such as constipation, mood changes, food cravings, neck stiffness, increased urination, or even frequent yawning.
Sometimes people may not even realize that these are warning signs of a migraine attack. In about a third of people living with migraine, aura might occur before or even during a migraine attack. Aura is the term that we use for these temporary reversible neurologic symptoms.
They’re usually visual, but they can include other neurologic symptoms as well. They typically built up over several minutes and they can last for up to an hour. Examples of migraine aura include visual phenomena such as seeing geometric shapes or bright spots, or flashing lights, or even loss of vision.
Some people may develop numbness or a pins and needles sensation on one side of their face or body, or even difficulty speaking. At the end of a migraine attack, you might feel drained, confused, or washed out for up to a day. This is called the post-drome phase.
How is it diagnosed? Migraine is a clinical diagnosis. That means the diagnosis is based on the symptoms reported by the patient. There is no lab test or imaging study that can rule in or rule out migraine. Based on screening diagnostic criteria, if you have the symptoms of headache associated with sensitivity to light, a decrease in function and nausea, you likely have migraine.
Please see your healthcare professional for the possible diagnosis of migraine and migraine specific treatment. How is it treated? Because there is such a wide spectrum of disease severity with migraine, there’s also a wide spectrum of management plans.
Some people need what we call an acute or a rescue treatment for infrequent migraine attacks. Whereas other people need both an acute and a preventive treatment plan. Preventive treatment reduces the frequency and severity of migraine attacks. It might be a daily oral medication, a monthly injection, or even injections and infusions that are delivered once every three months.
The right medications combined with lifestyle changes can be helpful to improve the lives of those living with migraine. There are ways to manage and minimize the triggers of migraine using the SEEDS method. The S is for sleep. Improve your sleep routine by sticking to a specific schedule, reducing screens and distractions at night.
E is for exercise. Start small, even five minutes once a week and slowly increase the duration and frequency to make it a habit. And stick to movement and activities that you enjoy. E is for eat healthy, well-balanced meals at least three times a day and stay hydrated. The D is for diary. Track your migraine days and symptoms in a diary.
Use a calendar, an agenda, or an app. Bring that diary with you to your follow-up appointments with your doctor to review. The S is for stress management to help manage migraine attacks triggered by stress. Consider therapy, mindfulness, biofeedback, and other relaxation techniques that work for you.
- What now? Migraine attacks can be disabling, but there are ways to manage the disease and to empower yourself to get the care and the support that you need. First.
- We need to end the stigma around migraine.
- It is not just a headache, it is a genetic neurologic disease.
- Next, talk to your healthcare professional about your symptoms.
Eradicate the words “I’m fine” from your vocabulary and be honest with your healthcare professional, your employer, your loved ones, about how you’re feeling as well as the kind of support that you need. Make yourself a top priority when you’re having a migraine attack and reduce the likelihood of attacks through lifestyle adjustments.
Have a consistent schedule, get adequate sleep, and learn strategies to cope with the stresses of life using mindfulness and meditation. Empower yourself to manage migraine with lifestyle changes and migraine specific treatment options. Together you and your doctor can manage the disease of migraine. If you’d like to learn more about migraine, watch or other related videos or visit mayoclinic.org.
We wish you well. A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.
- For some people, a warning symptom known as an aura occurs before or with the headache.
- An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
- Medications can help prevent some migraines and make them less painful.
The right medicines, combined with self-help remedies and lifestyle changes, might help.
What causes an earache in adults?
Outer ear infections (infections of the tube connecting the outer ear and eardrum) and middle ear infections (infections of the parts of the ear behind the eardrum) are very common causes of earache.