Dr. Frederick Godley, an ear, nose and throat doctor, explains how migraine presents in his patients.

There are multiple forms of migraine, each with unique symptoms and treatment options. Neurologists have found that the disease does not always present as head pain. Sometimes, it can cause a variety of symptoms ranging from intense sinus pressure to loud ringing in the inner ear.

During a recent Facebook Live event hosted by the American Migraine Foundation, Dr. Frederick Godley, an otolaryngologist practicing out of Providence, Rhode Island, discussed the many ways migraine presents at his clinic. As an otolaryngologist, Dr. Godley specializes in treating issues that pertain to the ears, nose and throat (ENT). Although he did not choose the specialty with a migraine focus in mind, he has become quite invested in how the disease can affect that region of the face and head.

“I became interested in migraine about 7 years ago,” said Godley. “I had been treating patients for quite some time by that point, and I began to notice an odd trend. Many middle-aged women would arrive at my practice complaining of recurring sinus infections, but their sinuses would look completely healthy on their CT scans. The few times that I did find abnormalities in their sinuses, they rarely made sense relative to the initial complaint.”

While trying to figure out an explanation, Dr. Godley stumbled upon other otolaryngologists who had treated similar patients in the past. That led him to research forms of migraine that could affect the nervous system, spontaneously creating sensations similar to sinusitis.

“In my journey with migraine, it has become increasingly clear that this is a disease that has a wide spectrum of presentations because there is a wide spectrum of genetic abnormalities that can cause it,” said Godley. “What I’m most interested in now is learning which of the symptoms I’m treating are in fact, migraine.”

During his talk, Godley discussed two migraine symptoms that can commonly cause misdiagnosis, and how the otolaryngology community is working together to increase awareness on these topics in the neurology sphere.



Migraine can cause a sense of general imbalance leading to frequent spells of dizziness. According to Godley, many of his patients have described the sensation as feeling like they just got off a boat.

“New research has made the medical community more supportive of using imbalance and dizziness as a diagnostic criteria for migraine,” said Godley. “Just recently a study established diagnostic criteria for vestibular migraine, or migraine with vertigo, meaning these symptoms are gaining recognition.”

Until recently, many people that experienced these unique migraine symptoms were misdiagnosed with Meniere’s disease or benign positional vertigo, a form of vertigo that causes dizziness when the head is moved too quickly at an angle.

“Otolaryngologists are now finding that migraine diagnosis is much more common than we thought,” said Godley. “About half of the people who make appointments with me due to recurring dizziness have migraine. It’s great that the symptom and its relation to migraine has gained this recognition because it allows us to create better treatment plans.”

Sinus Pressure

There is still much research to be done on the relationship between sinus issues and migraine. Physicians are currently experimenting with different treatment recommendations that are proving to be effective.

“Those of us within the otolaryngology community have been teaching ourselves to treat migraine by asking patients who are seeking help for sinus issues some broader questions than we have in the past,” said Godley. “If something in their history makes me think that their problem might be caused by migraine, then I treat it similarly to the way one might treat chronic migraine. The great news is, these patients are really responding to the migraine treatments.”

Godley is currently working with a group of otolaryngologists to further analyze the link between sinus issues and migraine. “As these cases continue to receive more attention from the medical community, there’s a better chance for people to receive the right treatment.”

Knowledge is a powerful tool for migraine management, so it’s important to stay up to date on the latest news and research. The American Migraine Foundation maintains a comprehensive migraine resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists. Visit AMF’s website to learn more and to find a headache doctor near you.