MAV and sinus symptoms?

While this is a little bit incidental and mild compared to most other MAV symptoms I have, I’m curious if anyone gets sinus symptoms with their MAV? I’ve read migraine in general can cause sinus issues that masquerade as other conditions, but I’ve never directly heard it with MAV.

Whenever I walk around or do any sort of physical activity beyond the (sedentary) norm for me, I always get an annoying “breathing under water” type feeling in my sinuses even though they’re clear. It goes away within maybe 30 mins after I stop moving around. It makes any attempts at even light exercise that much more frustrating.

It’s not a new symptom by any means, but one I’ve never had an explanation for. It does often come with worsening tension headache too, something which is definitely connected to my MAV.

For me, it’s just another one of those “is it a symptom? Or could it be a cause?” type things we all try to sort through as we go along :slight_smile:.


Hi Matt
I have been diagnosed with chronic migraine for 2 yrs, tried loads of meds which did nothing. Last Sept a sinus issue was uncovered for which I require surgery. You can read the detail in my posts below. In a nutshell, I have been told that migraine and sinus disease can have the same symptoms and it’s hard to tell the difference between them…the “conventional wisdom” is that migraine is much more common cause of headache and symptoms than sinus, particularly if you have no obvious sinus symptoms (congestion, nasal discharge, repeated infections). An ENT Professor I saw recently said I could have both migraine and sinus disease, or the sinus disease is triggering the migraine - only surgery will prove one or the other.

There are lots of people on here who have sinus/ear symptoms with MAV, For some people these symptoms disappear along with the migraine when migraine meds have controlled their symptoms. For me that didn’t happen despite trying 7 meds…I had a lot of facial pressure and an underwater feeling in my ears along with the headache and dizziness (but no congestion or nasal discharge)…this prompted me to have my sinuses checked…but still no guarantee that surgery will stop these particular symptoms as they could be migraine related rather than sinus related. Sorry there is no clear answer…


I’ve had sinus trouble for many years, always clearing my throat, sniffing, facial pressure, nasal pressure etc. I’ve told my Dr for years about it and even remember saying I feel like I need a bottle brush to clear my sinuses they’re so plugged. Always sent home with antibiotics, which never changed anything. After my onset of vertigo and an MRI was done of my brain and sinuses, I was absolutely shocked to hear them say my sinuses were clear! How could that possibly be!
Now having been diagnosed finally with MAV and being on week three of 50mg of Amitriptyline, I have no sinus pressure! No more sniffing, clearing my throat etc.
That feels amazing! So, I assume the sinus issues were migraine all along…

Hi Matt99. I get sinus symptoms with my ‘MAV’. I suffer from extreme migraines and vertigo and get the ear symptoms and sinus pressure. I always thought that I needed my sinus’s drained but I had a sinus cat scan which was noted as me having 'no significant abnormalites! The NHS failed to scan my ears though!I have pain in my sinus’s,ears and head and everything else! Good old NHS seem to only do part of the job and never get to the root cause!R.

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That’s interesting (and of course fantastic to hear from progress perspective)

Two points:

  1. Amitriptyline is a pain killer
  2. Amitriptyline reduces mucus output … this might have helped your sinuses.

Migraine is surely not a beginning (no-one truly healthy has migraines?), there must be a driver of the migraine?

Having chronic migraine tells us something is wrong, but not what is wrong.

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I get sinus symptoms. My whole journey with this started with investing my sinuses. I saw three ENT’s, had a sinus CT, got tested for allergies and tried treating it as if it were sinus related to no avail. Once I started being treated for migraine my sinus symptoms improved.

I’ve heard that sinus issues can cause migraine but if there can’t be any sinus disease or infection found then it could be related to migraine. Last year during the Migraine World Summit one of the speakers talked about this. He said the trigeminal nerve is often involved in migraine and branches into three place. If the top branch is affected then you get head pain that you typically see in migraine. If the middle branch is affected, which goes into the sinuses and teeth, then there is more a sensation of pressure instead of pain and sometimes other sinus symptoms like congestion. If the bottom branch is affected then it can cause jaw pain.

If it only happens when you exercise it could be exercised induced rhinitis.


Hi dizzyhead
Do you have any more info or could you point me in the direction of where I could get more info on exercise induced rhinitis - I am very interested to know more about this. Like Matt, I have pressure in the sinus region, mostly in the face, and when I go walking or do any activity for longer than a few minutes the underwater feeling (in my ears) gets worse.

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Thanks everyone for your replies!

Sounds like this isn’t an uncommon sort of issue. I don’t have any other chronic sinus issues luckily so maybe it’s just all MAV-related (@oak17 exericse induced rhinitis sounds curious, I’ll read up on that more).

My day-to-day symptoms aren’t well supressed with the meds I’m on (just the acute attacks – which of course is still great progress), so I’ll just pay attention to how the sinus symptoms ebb and flow with the MAV ones as I go through medicine changes.

My body is sort of a bundle of inflammation right now from auto-immune disorder, so any number of symptoms might also be indirectly related to that too. It’s hard to figure anything out…

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I have suffered massively with face and sinus pain and pressure. They felt almost at bursting point as i have wrote many times on this board. I also couldnt believe it when i was told my sinuses were fine!! Since Venlafaxine like yourself they have improved so much…


I have had sinus issues my whole life. After complaining constantly about the facial pressure, headaches stuffy nose, ear clogging when the sinus X-rays showed my sinuses were clear after being on antibiotics for a sinus infection, my allergist sent me to a neurologist thinking I could have migraine along with allergies. She diagnosed tension headaches. The tension headaches didn’t subside and I now had headaches along with vertigo, I went and got another opinion and saw Dr. Rauch who diagnosed MAV. My MAV gets worse when the sinuses are clogged. My neck pain and tightness are also a trigger. I have so many triggers but I am determined to get this under control. Its going to take a while but I am happy that I have the correct diagnosis.

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Just after stating my sinus issues have cleared lately… I have such incredible head pressure today that my teeth actually hurt!

Anecdotally sinus issues seem like a possible culprit for a proportion of MAVers., then.

If that’s the case we need to put pressure on doctors to stop telling us lazy things like ‘it’s migraine’ and properly investigate such issues rather than sending us away with pills! Treating the migraine may not be enough!

Given what I’ve read about ETD, it seems that blocked tubes might negatively influence inner ear fluid balance somehow and might cause some level of instability of sensory performance, perhaps leading to migraine and neurological fallout.

That paper states:

"It is very likely that dysfunction of the Eustachian tube disturbs the air pressure in the middle ear cavity and stimulates the perilymph, which interferes with balance, which is normally maintained by the labyrinthine mechanism. "

Perhaps sinus issues do something similar.

It’s also interesting that for both sinusitis and MAV, milk is discouraged:

I got my ‘MAV’ from injury and the one thing that injury did was started to cause fluid to build up in my Eustachian Tube. As this started to subside this started to block the tube I suspect. I didn’t get chronic MAV until about 6 months into this fluid build up. It’s possible that this caused subtle changes in homeostasis in my inner ear and this took many months to build up before symptoms began to be obvious (and very soon after overwhelming).

I have also had a diagnosis of possible PLF, but I think it’s also possible I gave myself a middle ear injury (bone fracture, muscle tear?) which lead to inflammation and mucosa build up (perhaps this is part of the repair process) … not unliike chronic sinus problems.

It’s also worth noting that another board member got excess fluid in her Eustachian tube from a cholesteatoma. This may have also been the mechanism for her MAV to develop. She got better because her doctor treated the cause.

Last migraine world summit, this was a topic of discussion. One of the doctors proved that migraine can cause sinus. He has a conical scanner in his office and they found no signs of infection. But at the same time they found the mucus and inflammation due to trigeminal irritation. He said most of the cases the antiobiotics worked due to the anti-inflammatory nature and not due to getting rid of infection. Once they treated the migraine the patients got significantly better. The name of the doc was Peter Goadsby, M.D.Professor of Neurology, Kings College London.

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I will be a test case of sorts…my sinus surgery is scheduled for this coming Thursday 24 Jan - I am actually terrified but I know that it has to be done. It will be interesting to see what symptoms remain after my recovery.

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I suffered 24/7 sinus pain/ pressure for 4 years along with Daily Headache and horrendous dizziness…until i started Venlafaxine and Botox treatment. So migraine prevention has certainly made a difference with my sinus issues.

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This also reduces mucus (hence dry mouth). That might be the one of the things going on.

I just read the post put up by @Carriep…what an awful experience she went through…so glad that she kept digging for answers, she was very lucky to have gotten the right diagnosis and treatment in the end.
Thanks for sharing the link James

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Ahh i didnt realise Venlafaxine reduced mucus…yes i have a very dry mouth as a side effect.

Sounds plausible to a point … someone with migraine history get’s overloaded mess of autonomic messages causing havoc with mucus production etc.

But what about people who’ve never had any serious neurological issues and no migraines, but a history of sinus issues and the odd related headache… I have serious trouble believing that was kicked off with migraine? And I think you’d know which group you belonged to.

They would have a clear sinus infection on the scan. And you treat them for Sinus. The conical scan in the doc’s office is used to catch this without having to send them on errands.

I was surprised to find Dr.Hain say the same thing. Infact i recorded my conversation with Dr.Hain, it is littered with a zillion golden nuggets of useful information for MAVers.