Sara would get headaches almost every other week. She reckons it is due to her irregular sleeping hours and general lack of sleep looking after two active toddlers. She takes comfort from her Google search that she is not alone.

Interestingly, studies show that there is a higher prevalence in primary nurturers such as women for migraine and tension headache.

Sara would usually endure the headaches. If it still does not go away after a nap, she would then take an over-the-counter pain reliever – and it does seem to go away after that, or so she thinks.

Little does Sara realise that by continuing to endure unnecessary pain, there is a negative effect on her emotional and psychological state, such as low self-esteem, depression, frustration and mood swings.

This would also affect those around her – like her children – as she would seem to be impatient and moody.

Overdependence on painkillers too would have undesirable long term effects.

According to a Pain Management Survey in 2014 by GlaxoSmithKline Consumer Healthcare, a research-based global pharmaceutical and healthcare company, headaches are the most common type of pain that affects 85% of Malaysians in the six months of its study.

Surprisingly, eight in 10 Malaysians choose to endure headache instead of treating it immediately. This indicates that there is a significant number of Malaysians tolerating pain unnecessarily.

Though the causes of headaches are commonly associated with neurological disorders such as lack of sleep or work pressure, a surprisingly high number have underlying ear, nose and throat (ENT) roots.

Some common ENT causes of headache are as follows:

Sinusitis – Sinuses are air-filled bony spaces within our skull and face. No one knows the real reason why we have these sinuses, but various theories have been postulated, including one which says that sinuses are meant to make our head lighter.

Sinusitis happens when these air-filled spaces are impacted with mucous, which usually occurs when we have prolonged flu or an upper respiratory tract infection.

Those who suffer from it would feel that their head is heavy and uncomfortable.

Often, patients mistake these symptoms as migraines. Migraine pain can be experienced on one side of the head or both sides. It can also last four to 72 hours in an adult.

During a migraine, other symptoms like nausea and sensitivity to light and sound may arise.

At times, the pain from sinusitis can be so severe that it is not only confined to the face but radiates all over the head.

To treat sinusitis, the doctor must firstly confirm the diagnosis. The gold standard to confirm the diagnosis of sinusitis is through a CT scan of the sinuses.

Most patients who complain of headaches would usually be advised to undergo a CT scan or an MRI of the brain.

Once the diagnosis is confirmed, treatment can be conservative or surgical, depending on the extent of the disease. Conservative treatment includes antibiotics and nasal sprays.

Surgery would involve widening the existing opening into the affected sinuses and draining the mucous off from the sinus as well as to ventilate these cavities.

There have been various methods advocated to widen these openings. Currently, the least invasive method I use with my patients is balloon sinoplasty.

This method is very similar to an angioplasty where we use a balloon under endoscopic guidance to dilate the opening and thus aid in draining and ventilating the sinuses.

The benefit of this method is that there is no surgical “cutting” involved and the patient can be discharged on the same day or the very next day after the procedure.

It is also interesting to note that the symptom relief is seen immediately after surgery.

Sludder’s Neuralgia (contact headache) – As the name suggests, this is a form of neuralgia (nerve pain). First described in 1908, the pain is typically felt on one side of the head and face. This occurs when the nasal septum, which is supposed to be straight, is deviated (bent) to one side of the nose.

The sharp bent portion of the septum impinges on the inside of the nose, and this results in “compression” of the nerves, which then triggers the pain.

In simpler terms, there is an anatomic spot within the nose where the nerve gets compressed between two structures. The pain distribution in the face and head depends on the exact nerve that is compressed.

Treatment involves confirming the diagnosis by the ENT doctor. Endosocpically, we can visualise the deviated septum, and this can be confirmed by a CT scan as well.

Treatment may involve using a simple decongestant, which reduces the contact between both structures and prevents compression of the nerve.

On occasion, surgery may be indicated to straighten the deviated septum.

Impacted wax – Ear wax is produced by glands within the ear canal. There is no exact reason as to why ear wax, a sticky yellowish waxy substance, is secreted, but it has been claimed to protect the ear drum from dust and particles by trapping them.

For most people, wax comes out on its own. However in some cases, the wax gets tightly impacted within the canal.

The wax will then press on the eardrum and cause constant irritating pain, which is not only confined to the ear, but also tends to radiate to the entire head.

Treatment involves removing the wax, firstly by using a softener, and secondly by suction removal by an ENT surgeon.

So if you have a prolonged headache and “migraine” that does not seem to go away with pain relievers, it may be wise to consult an ENT.

Don’t live with the pain as it will hamper your quality of life. The sooner you get it diagnosed, the better it will be for your personal well-being and those around you.


Dr Muthu Kumar is a consultant ENT, Head & Neck Surgeon. This article is courtesy of Manipal Hospitals Klang. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.