EBHSG - AUGUST 1997 MEETING

TOPIC: "ARE YOUR HEADACHES CAUSED BY ALLERGIES?"

Nathan Schultz, M.D., is an allergist and a member of the Clinical Research Division of the Allergy & Asthma Medical Group of Diablo Valley in Danville. He was invited to speak to the August 12th meeting of the East Bay Headache Support Group about the relationship between allergies and headaches. The meeting was held in the Ball Auditorium at John Muir Medical Center with 29 people in attendance.

Dr. Schultz began his presentation with a slide show on allergies in general, and then he went on to talk about headache syndrome related to allergies and opened it up for questions.

Allergies are very common, affecting 25% of the population. In contrast, 10% of the population reportedly suffers from migraines. Allergy is a state of hypersensitivity to certain things (pollen, food, animal dander, etc). Approximately 50 million Americans suffer from allergic rhinitis (an inflammation of the nose), which is a seasonal affliction for the majority.

How do allergic reactions come about? The body makes IgE antibodies against a substance called an allergen. On re-exposure, the allergen combines with IgE (allergic) antibodies on the surface of mast cells and triggers chemical reactions and produces histamine.

Dr. Schultz stated that especially for his presentation to the headache group he reviewed many books and articles about allergies, and in his research he found that headache was never listed as a specific allergy symptom.

Allergic rhinitis can be associated with more serious diseases. 58% of adults go on to develop asthma, and 33% have sinusitis. Also, sleep apnea, nasal polyps, and otitis media are related to allergic rhinitis.

In 65 B.C, Lucretius said, "What is food to one man may be fierce poison to others." He was talking about how some people are not affected by certain foods or substances, whereas others may be extremely allergic. Under Adverse Food Reactions Dr. Schultz’s slide listed Food Intolerance:

* Toxicity (poisoning)

* Pharmacologic

* Metabolic

* Idiosyncratic (unexplainable)

and Food Hypersensitivity.

Some foods many adults can’t tolerate are: fish, shellfish, tree nuts, peanuts, and eggs.

Dr. Schultz said that foods can trigger migraines in some people. You just can’t trust all the skin tests when trying to determine a food allergy. It takes a blind challenge. If you suspect an allergy to lots of foods, you will have to do some detective work to search them out.

Dr. Schultz recommends skin testing over RAST testing (blood test).

What can be done for food hypersensitivity? Once you identify the offending food(s), avoid it(them). Avoidance is often the "best medicine."

What can you do for seasonal allergic rhinitis? The best Rx is to avoid pollen. Otherwise, use decongestants and intranasal cortisone sprays, but don’t take them continuously. Chronic use of these drugs can precipitate a headache when you stop taking them. Consider taking allergy shots if your symptoms are bad.

At the end of the slide show, Dr. Schultz again stated that he found nothing in his medical journals about allergy headaches. He did, however, go on to mention some who have conducted studies about allergies. Dr. Eger many years ago studied patients with food allergies and tried food elimination diets. He found that the most common foods to trigger allergies were eggs and chocolate. Dr. Schultz warned not to try to eliminate multiple foods from one’s diet, or you would be at risk for malnutrition.

In 1985 Lyndon Mansfield in San Antonio did allergy scientific research on headaches, but Dr. Schultz said he could find nothing new on the subject since then.

There are both negative and positive studies relating food allergies to migraine. Haddington and Harper conducted a food study and found that tyramine didn’t necessarily cause food allergies in people, even though it seems like every list you see of foods that a migraine sufferer should avoid has tyramine near the top of the list.

What should you do if you suspect your headaches are related to allergy?

1.) Keep a diary of your food intake and headaches. Is there a relationship?

2.) Keep a diary of your response to medications.

3.) Have skin testing or RAST testing done by your doctor or lab.

4.) Conduct an open or blinded challenge.

The circulating antibody (IgE) is in your skin and everywhere. It is detectable by skin testing or RAST testing.

Dr. Schultz asked the audience if there were any questions at this point. Dr. Michael Stein asked him, "How do you diagnose a sinus headache?" Dr. Schultz told us chronic infection is the No. 1 cause of a real sinus headache. Also, pressure changes caused by the sinus being blocked by allergy will produce pain. Negative pressure hurts, but when the sinus is opened, the pain goes away.

How can we treat sinus headaches? Dr. Schultz said he would try antibiotics first to treat the sinus infection, and if that failed, then he would perform functional endoscopic surgery to drain the sinus. Chronic sinus infection can be brought on by an allergy, or tissue injury.

One member of the audience stated that she suffers from sinus headaches frequently, but tests have revealed nothing.

Dr. Schultz said that your sinuses are outside of your body--no blood vessels run through them.

Dr. Schultz said that some physicians say that sinus headaches are real, whereas others say there is no such thing. According to Dr. Schultz, allergy causes congestion in the sinus, the blocked opening causes negative pressure, which causes pain. Or, if it’s chronic, make certain it’s not chronic sinusitis. He is seeing an increased incidence of antibiotics failing to clear up the infection. Germs are developing a resistance to antibiotics. It has been noted that susceptability to chronic sinusitis is somewhat inherited.

Dr. Stein then conducted an informal poll of those in the room to determine how many suffer from sinus headaches and migraine headaches. Dr. Stein also said that he has seen patients who have started out with a sinus headache which then developed into a migraine.

Diagnosis leads to the correct treatment for your condition. Dr. Schultz said it doesn’t matter what your condition is called, whether it’s a sinus headache or whatever, what matters is getting rid of the pain. Calling it a sinus condition may block you from going down the path to relief.

Dr. Schultz has his patients describe their symptoms. He can diagnose by finding out if the patient responds to a particular treatment or not. He said a large number of people have colds which develop into sinusitis. One member of the audience said she has problems taking antibiotics and she asked if she could get better on her own, without taking antibiotics.

Dr. Schultz said, "Yes, over a two to three week time if your immune system is good the symptoms should clear up on their own." It is estimated that about three-fourths of acute sinus infections will get better without antibiotics.

Nasal membranes can get dried out which causes pain. Use saline irrigation to get rid of the burning feeling in your nose.

Dr. Stein asked, "When is it appropriate for a headache sufferer to see an allergist?" and Dr. Schultz answered, "When what you’re doing doesn’t help." If over-the-counter medications don’t work, it’s time to test for allergies.

Dr. Schultz went back to talking about food allergies. If you have a headache every other day, try eliminating a possible food trigger for one week. Or, if your headaches are weekly, eliminate the food for three weeks as a test.

There is a difference between food intolerance and food allergy. So many people have fatal reactions when they ingest peanuts that scientists are working hard on peanut allergy desensitivation. Peanuts are the No. 1 allergy for children. Children seem to absorb more undigested food than adults. Most life-threatening reactions occur within an hour. This is "immediate hypersensitivity." One audience member said that her five-year-old ate lots of peanuts once and then developed hives. Now the mother is afraid of what will happen the next time her child eats peanuts. What should she do? Dr. Schultz told her to take her child to a doctor for a RAST test or skin test to make certain that she isn’t allergic to peanuts.

Another member of the audience asked Dr. Schultz about his headaches. He wakes up every morning with pain across the bridge of his nose, and is congested, and then he develops a migraine. Dr. Schultz suggested he determine if it’s a seasonal occurrence, and whether a change of pillow or sleeping place makes any difference. He stated that morning congestion is a sign of allergy.

Dr. Schultz’s hand-outs provide more information about allergies and can be obtained by contacting the EBHSG.

The notes provided above were taken by an EBHSG volunteer and have not been reviewed by the speaker for accuracy. If you have any questions regarding the notes, please contact the EBHSG.

It is the intention of the East Bay Headache Support Group is to provide information and resources. It does not provide medical advice, which should be obtained directly from a physician.