Stuffy head or migraine?

I’m not sure if it’s my freshly diagnosed autoimmune issue, my mucositis (yech), or just bad luck, but I’ve gotten lots more colds in the last couple of years than I ever had before. I don’t mind them so much–sometimes I enjoy the scratchy, sultry voice (it allows me sing in lower registers as I belt along with the radio in my car–I’m amazing).

Perhaps it’s not the frequency of colds but their duration that has changed in recent years. I used to get a cold for 2-3 days and then have little to no trace of it left. Nowadays it seems my cold develops slowly and takes a long time to leave. This one’s been around for at least a week and a half. It started with sneezing and stuffy-headed-ness. Then it moved into my throat, where it settled in and made it hard for me to speak loudly enough for people to understand me well. After my voice started coming back early last week, I figured the cold was on its way out. WRONG. It moved back into my head, focusing mainly on the left side of my sinus cavity.

Here’s the rub: I can’t always tell the difference between the beginning stages of a migraine and sinus congestion. From what I understand, a lot of migraineurs confuse the two. (Let’s not rehash the sinus headache issue here, though.) This past Wednesday, I went to bed early with a congested head; I woke in the middle of the night a couple of times because my head was so heavy and it was hard to breathe. After awaking Thursday and walking around the house a bit, I realized I was not suffering from just sinus congestion: I had a migraine that was rapidly progressing. I kicked myself for not having taken a triptan in the middle of the night.

But it had been so hard to tell the difference between sinus pressure & the early stages of migraine!

This morning I awoke with so much sinus congestion on the left that I immediately opened my bedside table drawer to get a Maxalt tab. There was no such tab in the drawer, so, favoring another hour in bed over getting up to look for my triptan pill, I took a nasal decongestent (I have an emergency drug arsenal next to my bed, of course). Upon waking in earnest, I dared to try my neti pot again. (Months ago I had a strange experience wherein using my neti pot led to an immediate and severe migraine–not sure how I screwed up, but I did and it HURT. I’ve been scared to try the pot again ever since despite its having worked wonders pre-pain-incident.) I can’t claim that any one thing cured today’s head issues, but the decongestent + neti pot flush rid me of the migrainey feeling I had. Interesting.

Do any migraineurs (or folks with sinus problems like me) have any tips as to how to know when to use a triptan and when to focus on the sinuses? How do you tell the difference between the beginning of a migraine and a side effect of sinus problems?

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