How to relieve sinus pressure

Sinus migraines can be debilitating

You have a headache. It extends over your eye and you have pressure in your face Your nose even runs a little. You take some Sudafed or ibuprofen, tell everyone you have a sinus headache or even a sinus migraine, and lay down for a while. Two or three hours later you are better. You might have a little residual soreness and you might be a little tired, but the worst of the headache is over. You’ve just had a sinus headache – or was it?

You could have had a migraine that isn’t even related to any sinus issues and not realize it. You felt sinus pain and pressure, so your mind automatically went to sinus headache. It’s a logical conclusion. You doctor may even have told you it was sinus related and the subject of migraines never came up. It happens a lot more than you might think. In fact, nearly 90% of patients who visit their doctor and complain of “sinus headache” actually have a migraine or tension headache.

Some people call it a “sinus migraine” because the symptoms so closely resemble a sinus headache. “Allergy migraine” is another common term. However, researchers have found that there are distinct differences between a migraine and a sinus headache. In fact, some doctors say that the headaches that many people believe are related to sinus issues are actually migraines.

Axon Optics talked to Dr. Jessica Ailani, Director of Medstar Georgetown Headache Center and Associate Professor of Neurology at Medstar Georgetown University Hospital about sinus migraine versus sinus headaches. She says, “Often, patients with a headache disorder will have seen their primary care physician (PCP) and been treated for a sinus infection, then referred to both an ear, nose, and throat doctor (ENT) and an Ophthalmologist before they eventually make their way to a Neurologist. One of the reasons for this is that a number of headache disorders, including migraine, can have symptoms very similar to sinus problems.”

How to Relieve Tooth Pain from Sinus PressureDo I  See My Dentist or Doctor?

Take a look at your symptoms. If you are unsure, start with your dentist.They will  look at x-rays and the condition of your teeth to determine if you are grinding your teeth, have a tooth abscess, a cavity or other tooth and jaw related problems.

If your dentist determines all is well, the next step can be to your doctor or urgent care who can determine if you have a sinus infection or congestion and prescribe the right kind of allergy relief, antibiotics or pain relievers.

How to Relieve Tooth Pain from Sinus Pressure

Is there really a “sinus migraine”?

Technically, the answer is no. There are migraines and there are sinus headaches. They are not the same, but some people have coined the phrase “sinus migraine” to make the distinction that their migraines seem to have a sinus component. They may be familiar enough with migraines that they know the typical symptoms, so they rule it out because their headaches don’t fit that mold. The truth is, there are many different types of migraines and headaches – and they often have very similar, if not identical, symptoms.

Dr. Ailani explains, “Migraine pain can be located in the temples or back of the head, but often is in or around the eye and can, on occasion, be located under the eye, around the nose, and into the jaw.  The reason for this is that the nerve that causes facial sensation and sinus sensation and the one that also causes facial and sinus pain, are one and the same, the trigeminal nerve.”

She continues, “When this nerve is turned on, you can experience pain- which can be all different types such as pulsating, throbbing, pressure, searing, jabbing, tingling, and burning, anywhere in your head and face. This nerve also connects to other nerves at the back of the neck and in the sinuses. When one nerve decides to be turned on, other connected nerves can follow- where there is a party, all like to join in!”

Many people mistake this migraine activity to be a sinus headache or sinus migraine, then become frustrated when their sinus medication doesn’t help their pain (although sometimes it can). Understanding the differences between the two can help you manager your headaches better and it could even help you prevent them altogether.

Sinusitis and Sinus Headaches

What most people don’t realize is that true sinus headaches are actually quite uncommon and are often over diagnosed or misdiagnosed. Sinusitis is an inflammation of the sinuses, often due to a bacterial infection. The sinuses are air pockets that are situated at certain points in the facial bones. Scientists are not certain the exact purpose of sinuses. Some believe that it helps enhance the voice through resonation while others believe it may be a way for the body to humidify the air during inhalation. They are usually empty but do have a very thin mucus layer along the walls.

There are four pairs of paranasal sinuses, meaning that there are two at the same points on the left and right. They are:

  • Frontal sinuses: above the eyes just over the eyebrows
  • Maxillary sinuses: on each side of the nose, in the cheekbone
  • Ethmoid sinuses: between the eyes, under the bridge of the nose
  • Sphenoid sinuses: behind the eyes and ethmoid sinuses

Inflammation of the sinuses can occur due to bacterial, viral, or fungal causes and can present in one of the sinus pair, or several. If there is an infection present, it is important that it is treated. Failure to properly treat a sinus infection can cause serious health risks and can create a propensity to develop sinus infections in the future.

Can a sinus headache cause a migraine?

A common misconception is that sinusitis triggers migraines (hence the term sinus migraine), but that isn’t likely to happen. Sinusitis originates in a different region of the body than migraine and they are not necessarily connected However, the two conditions do share the same nerves that can be stimulated, and they do both produce many of the same chemicals in the body during an attack. There are certain signs that can help distinguish between the two and knowing this can help facilitate appropriate treatment of the condition that is present.

Dr. Ailani explains how easy it can be to mistake a migraine for a sinus headache:

“With a sinus infection, you will often have a fever, bright colored mucus from the nose in large amounts, and pain that is worse when you lay down (as the fluid collects into your sinuses). You may notice the pain is worse in the morning after sleeping for several hours. Occasionally, someone may have a chronic sinus infection, something that has been going on for several months. In this case, a person may not have any symptoms, and may not have a headache either.

If you have a severe headache with sinus type symptoms (like congestion, eye watering) and also have light or sound sensitivity, upset stomach, lack of appetite, and no fever, and you notice the pain resolves in 4-36 hours- this may be a migraine.  If you notice the pain improves when laying in a dark, quiet room, or when taking over the counter pain medication, this again goes along with migraine.”

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Tension headaches are also often mistaken for sinus headaches. Interestingly, tension headaches are often misdiagnosed as well, but tension can also bring on a migraine attack. All of these conditions are so much alike it can delay an accurate diagnosis or prevent it altogether.

Symptoms of a migraine

Migraines can vary from person to person and even from attack to attack. There are a wide range of migraine symptoms, but the most common include:

  •         Head pain, often over one eye or on one or both sides
  •         Sensitivity to light
  •         Nausea and vomiting
  •         Facial pressure (pressure and/or pain can worsen when bending forward)
  •         Facial tenderness to the touch
  •         Sensitivity to sound
  •         Fatigue
  •         Visual disturbances such as flashing lights or visual snow
  •         Nasal congestion
  •         Nasal discharge that is clear and watery
  •         Watery eyes

Symptoms of a sinus headache and sinusitis

Sinusitis and sinus headaches share many of the migraine symptoms, except for photophobia, nausea, vomiting, and phonophobia. These symptoms are almost always exclusive to migraines in these cases. Symptoms of a sinus headache and sinusitis include:

  •         Head pain behind the eyes or on one or both sides including the forehead, nose, and cheeks
  •         Fever
  •         Sore throat
  •         Achiness in upper teeth and jaw
  •         Fatigue
  •         Tenderness and puffiness or swelling of the forehead, nose, cheeks, and eyes
  •         Nasal congestion or stuffiness (can include varying degrees of obstruction from partial to total)
  •         Difficulty breathing through the nose
  •         Nasal discharge that is thick and discolored (usually bright yellow or green)
  •         Sense of smell is reduced as well as sense of taste
  •         Bad breath
  •         Snoring
  •         Ear pain
  •         Coughing (especially in children)

To further compound the confusion between these two conditions, even treatment options are similar. Many people are very surprised to discover that sinus medications and treatments relieve their migraine pain. Dr. Ailani explains:

“Migraine can improve when using products like Sudafed or Advil cold/sinus. These medications work to reduce some of the chemicals that are elevated during a migraine, so don’t be fooled into thinking that if you feel better with Sudafed, it is a sinus issue. Overuse of these medications can lead to more headaches, so if you find yourself using these medications more than 2-3 days a week, seek medical attention for an appropriate diagnosis.”

A diagnosis of either a migraine or a sinus headache is the first step in finding treatment that works.

Treatment for migraines

There is no known cure for migraines and many migraineurs struggle to find a treatment that works. There is a lot of research currently underway as doctors and scientists continually seek effective relief options. Migraine medications tend to be expensive though, so some people turn to natural migraine remedies. Other treatments include migraine release surgery, Botox injections, migraine glasses or migraine contact lenses, and electrical and magnetic stimulators.

“Migraines with symptoms similar to sinus pain or pressure are not treated any differently than migraines without those symptoms,” says Dr. Ailani. “For attacks of migraine, we use what are called acute therapies. These are medications you take at the start of the attack to improve pain and associated symptoms.  Medications range from over the counter options, like acetaminophen and ibuprofen for milder attacks, to prescription medications for more moderate to severe attacks, or fast onset attacks.”

She continues, “The most commonly prescribed migraine specific acute medications are in a category called triptans. They are designed to specifically reduce certain chemicals in the brain that are out of control during a migraine attack. They come in pill form, nasal forms, and injections, to help match your symptom need. For example, if you feel nauseated during a migraine, swallowing a pill can be hard, so using a nasal form may be preferred. If you wake with a severe migraine or are vomiting, an injectable form may be preferred.”

She concludes, “If you are having frequent migraines, meaning you have them more than 1 day a week, or the migraine attacks are disabling, you may be a candidate for preventive treatment. This is the use of medication daily to reduce the frequency of migraine attacks, allowing you to use less acute medication and improve daily functioning. There are a variety of preventive treatments, so it is best to see a provider to find out what option is best for you.”

Treatment for sinusitis and sinus headaches

Some aspects of the treatment for sinusitis and sinus headache (or sinus migraine) are not all that different from migraine treatments. The treatment goals are:

  • To reduce inflammation
  • To facilitate draining of the nasal passages
  • To identify any underlying causes and eliminate them
  • In the case of chronic sinusitis, reduce the number of attacks or flare-ups

These are very similar to migraine treatment goals: reduce the pain of the attack, facilitate the treatment of comorbidities or symptoms that compound the discomfort, identify any triggers and eliminate them, and in the case of chronic migraine, reduce the number of attacks.

Sinusitis treatments include a combination of symptom relief and addressing the cause. They may include:

  • Oral, nasal, or injected corticosteroids
  • Saline nasal irrigation
  • Warm compresses applied to the face
  • Moisturizing nasal spray
  • Steam treatment
  • Aspirin desensitization treatment
  • Acetaminophen or ibuprofen for fever and pain
  • Antihistamines (prescription or over the counter)
  • Antibiotics (if the cause is bacterial)
  • Environmental changes such as a humidifier or dehumidifier in the home
  • Immunotherapy
  • Surgery

In cases where a sinus migraine or sinus headache is present, treating the symptoms and condition will usually relieve the headache.

Talking to your doctor about your headaches

Your search for a migraine diagnosis and relief from your headaches usually begins with your primary care provider. He or she may send you to several specialists before you get answers, or you may go directly to a headache specialist or neurologist. In other words, you may find that you are repeating yourself to each new doctor. Don’t let this discourage you. Sometimes it takes a little digging and searching to get answers, but it is worth it. Create your own headache file with notes and documentation from doctors’ visits and tests as well as your migraine diary.

Dr. Ailani has this advice: “Keep track of your headaches, write down when they happen, how long they last, and what symptoms come with the headache.”

She also recommends noting specific characteristics of your headache or migraine by considering these questions:

  • Do you prefer to be in the dark, or in a quiet area with a headache?
  • Do you find your stomach gets upset and smells bother you?
  • Would you prefer to sleep if you could?
  • Do your headaches last several hours or several days?
  • Have your parents, siblings, aunts/uncles, grandparents, and cousins ever had headaches? Migraines tend to run in families, but most families don’t discuss this.
  • What have tried for your headaches? What works or does not work?
  • How have your headaches changed over time?
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Dr. Ailani stresses that this is the best way to approach your search for a diagnosis from the very start. “Bring this information to your primary care provider to discuss and ask for advice on how to better manage headaches,”

She says that if you don’t respond to the first step treatments, you may then be referred to a Neurologist or headache specialist for further diagnosis and management. Getting a diagnosis may not be a simple and straightforward as we’d all like, but once you get it you can begin moving towards getting relief.

Allergy, sinusitis, and sinus headache resources

There are a number of very good resources available for people suffering from allergies, sinusitis, and sinus headaches:

Migraineurs can use the search feature on the Axon Optics blog to find information on specific migraine types, migraine treatments, tips for coping with migraine related issues like light sensitivity, and much more.

References and Resources (Yes, we did our homework): The information in this article is based on an interview with Jessica Ailani M.D. who is the Director of the Medstar Georgetown Headache Center and Associate Professor of Neurology at Georgetown University Hospital.  Additional info came from over 15 references including Dr. Goadsby’s article from The Journal of Headache and Pain. 

References & Resources

  1. Jessica Ailani M.D. FAHSDirector, Medstar Georgetown Headache CenterAssociate Professor NeurologyDepartment of NeurologyMedstar Georgetown University Hospital

    Dr. Jessica Ailani, MD

  2. Al-Hashel, J. Y., Ahmed, S. F., Alroughani, R., & Goadsby, P. J. (2013, December 12). Migraine misdiagnosis as a sinusitis, a delay that can last for many years. Retrieved from https://thejournalofheadacheandpain.springeropen.com/articles/10.1186/1129-2377-14-97
  3. Bono, F., Messina, D., Giliberto, C., Cristiano, D., Broussard, G., Fera, F., . . . Quattrone, A. (2006, August 08). Bilateral transverse sinus stenosis predicts IIH without papilledema in patients with migraine. Retrieved from http://n.neurology.org/content/67/3/419.short
  4. Cady, R. K., & Schreiber, C. P. (2002, May 14). Sinus headache or migraine? Retrieved from http://n.neurology.org/content/58/9_suppl_6/S10.short
  5. Chronic sinusitis. (2016, July 01). Retrieved from https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/symptoms-causes/syc-20351661
  6. C.  (2018, January 03). Sinus Headaches. Retrieved from http://www.entnet.org/content/sinus-headaches
  7. December;62(12):752-754, J. F., & Author(s): Christopher Boisselle, MD Richard Guthmann, MD, MPH Kathy Cable, MLS. (2016, December 13). What clinical clues differentiate migraine from sinus headaches? Retrieved from https://www.mdedge.com/jfponline/article/79122/pain/what-clinical-clues-differentiate-migraine-sinus-headaches
  8. Diamond, M. L. (2002, May 14). The role of concomitant headache types and non-headache co-morbidities in the underdiagnosis of migraine. Retrieved from http://n.neurology.org/content/58/9_suppl_6/S3.short
  9. Eross, E., Dodick, D., & Eross, M. (2007, February). The Sinus, Allergy and Migraine Study (SAMS). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17300361
  10. Eross, E., Dodick, D., & Eross, M. (2007, February 13). The Sinus, Allergy and Migraine Study (SAMS). Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00688.x/full
  11. Jones, N. S. (2009, April). Sinus headaches: Avoiding over- and mis-diagnosis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19344297
  12. Migraine Symptoms. (n.d.). Retrieved from http://www.axonoptics.com/migraine-symptoms/
  13. Optics, A. (2016, October 04). Headache or Migraine? How You Know the Difference. Retrieved from http://www.axonoptics.com/2016/09/headache-migraine-know-difference/
  14. Optics, A. (2017, December 27). Natural Migraine Remedies: A Comprehensive Guide. Retrieved from http://www.axonoptics.com/2017/11/natural-migraine-remedies/
  15. Optics, A. (2018, February 28). Visual Snow Guide | Everything You Wanted to Know About Visual Snow. Retrieved from http://www.axonoptics.com/2017/03/visual-snow-guide/
  16. Optics, A. (2017, November 17). What Migraine Medications are Available to Me? Retrieved from http://www.axonoptics.com/2017/08/migraine_medications_available/
  17. Schreiber, C. P., Hutchinson, S., Webster, C. J., Ames, M., Richardson, M. S., & Powers, C. (2004, September 13). Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15364670
  18. Schreiber, C. P. (2004, September 13). Prevalence of Migraine in Patients With a History of Self-reported or Physician-Diagnosed “Sinus” Headache. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217302
  19. Sinus Headaches. (n.d.). Retrieved from https://www.fauquierent.net/sinusheadache.htm
  20. Sinus headaches. (2015, March 18). Retrieved from https://www.mayoclinic.org/diseases-conditions/sinus-headaches/symptoms-causes/syc-20377580
  21. Types of Headaches Guide. (n.d.). Retrieved from http://www.axonoptics.com/types-of-headache-guide/
  22. US8676330B2 – Electrical and magnetic stimulators used to treat migraine/sinus headache and comorbid disorders. (n.d.). Retrieved from https://patents.google.com/patent/US8676330B2/en
  23. Sinusitis. (n.d.). Retrieved from https://medical-dictionary.thefreedictionary.com/sinusitis

 Searching for a Sinus Headache Cure

While there may not be one definitive sinus headache cure yet, sticking to an anti-inflammatory sinus diet is certainly on the right track. Alongside healthy eating, over-the-counter medications like Vanquish target specific sinusitis symptoms, like sinus headache. Steam inhalation, salt water rinses, and light exercise to improve blood circulation may also accompany these remedies to bring relief and help the body naturally cure itself.

Product Always have Vanquish® on hand to provide effective, yet gentle headache relief. view product info ❯

Dr. Bennett’s 7 Tips for Minimizing Sinus Discomfort during Flights

Low moisture content, increased infectious agents, and pressure changes during ascent and descent ‘can all contribute to sinus problems. Take care to follow these SEVEN IMPORTANT TIPS as preventative measures to minimize the potential damaging effects that that air travel can wreak on your sinuses.

(1) Use a saline solution during the flight to minimize the damage caused by the dry air and low humidity.

Pack a small bottle of saline solution in your carry-on luggage or stow-away bag (3 ounces or less), and use it approximately once an hour, in an effort to maintain moisture in the nose. Over-the-counter saline solutions are readily available in travel sizes.

 (2) Carry a decongestant spray with you to use before you board your flight and/or before descent.

If you have sinus pressure during flights then you should bring along a decongestant spray (Oxymetazoline or Phenylephrine), found in the nasal aisle at the drug store, and use it approximately one hours before a flight of any duration. This will assist in clearing your nasal passages and ensuring proper sinus ventilation during and throughout your flight. You can alternatively take an oral decongestant like (Pseudoephedrine or Phenylephrine) an hour before the flight as well. You need to use caution as decongestants can cause nasal dryness by opening the nose more and exposing the inside of the nose to dry air. A decongestant spray can also be used to slow a nosebleed should one occur.

(3) Drink between 5-8 glasses of water before and during exceptionally long flights (international and cross-country domestic).

The poor ventilation felt at high altitudes contributes to the dry air in the interior cabin, and drinking water will combat the lack of moisture in your body. Drinking water not only ensures proper moisture levels in the body, but also, more importantly, preserves a moist nasal system.

Alleviate your Sinuses

Steam your Sinuses

(4) Steam the Sinuses.

An airplane has the same relative humidity as a desert. The dry air decreases the flow of mucus in the nose and lets bacteria  and viruses stick to the dry mucosa inside the nose. A deviated septum will cause the open side of the nose to become even more dried out. Dry air can also stimulate a sinus infection in those predisposed to acute or chronic sinusitis. Breathing in the steam from an herbal tea will allow the sinuses to clear themselves in about 15 minutes and decrease the chance of a sinus infection.

(5) Avoid caffeine & alcohol.

It is also extremely important for passengers to avoid alcohol and caffeine on long flights, despite their popularity, because these beverages contribute to dehydration and a loss of moisture. Therefore, prevent over-drying of the nasal passages by avoiding these drinks and by substituting them with glasses of water during your flight.

(6) Complete the “Modified Valsalva” maneuver, an exercise whereby one closes one’s mouth, lightly pinches one’s nose shut with the thumb and forefinger, swallows, and blows into the nose without releasing the thumb and forefinger. This maneuver works to clear the sinuses and eardrums and normalize the pressure in one’s head during liftoff and landing.

Special Note: Dr. Bennett encourages individuals who complete this technique to take care not to blow too powerfully. Also, Dr. Bennett recommends that the maneuver ought to be completed several times per minute during liftoff and landing – the times when the changes in cabin pressures are most noticeable. It is also helpful to complete the exercise a few times per hour once the plane is in the air.

EarPlanes are a specially designed product first created by the Air Force that function as a great way to regulate air pressure in the ears during a flight. These special, discreet, earplugs minimize ear discomfort during the plane’s ascent and descent, while still allowing you to hear normally. They can be worn while using headphones during the flight. EarPlanes are inexpensive (typically under $10) and are available at drugstores and kiosks in the airport, so they are widely available and also won’t put a strain on your wallet in the name of sinus health.

(7) Wear warm clothing or bring along a sweater, as the interior cabin of the plane is usually kept at a cool temperature.This will prevent you from fatigue or chill during your flight. Cold doesn’t cause viral infections but it may weaken your immune response to viral exposure.

Keeping in mind these 7 simple tips can prevent you from that take-off and landing sinus discomfort. Following the rules of healthy sinus care will allow air travel and your sinuses to get along so you can fly in comfort.

Healthy Flying

Healthy Flying

Why the Confusion Between Sinus Pressure and Migraines?

Sinus pressure causes headaches, right? Sure, it’s possible. However, always thinking of the connection as being unilateral, or just going in that direction, can easily lead to misdiagnosis. Sometimes the headache is a sign of migraines, and sinus pressure is just one more symptom.

How can you determine if your sinus problems are actually migraine related? The American Migraine Foundation offers 3 diagnostic inquiries:

  • Are the headaches disabling (i.e., you can’t work or you miss social events)?
  • Are you nauseous during your sinus problems?
  • Do you suffer from sensory sensitivity?

If even two of these three other symptoms are present, you have a greater than 90% chance of being a migraineur rather than simply having sinus headaches.

Why is this information important when it comes to seeking care for your sinus pressure? Quite frankly, it is because the success of care depends on knowing the underlying problem. You can’t treat sinus issues and expect to feel better if you are actually suffering from migraines that have sinus pressure as one symptom.

Sinus Pressure and the Importance of the Atlas

If your sinus pressure is migraine related, the atlas plays an important role. Atlas is the nickname of the C1 vertebra. It’s located at the base of the skull, and that’s where the name comes from. It holds up the head, just like the mythological Atlas balanced the weight of the world on his back. Because of its important location, the atlas can have a powerful effect on the body.

First of all, it protects the brainstem. This is where the spinal cord and brain meet. It is both a hub for the signals being sent throughout the body as well as the center of control for the majority of the body’s involuntary processes (i.e., breathing, swallowing, sleeping, etc.). If a misalignment causes the brainstem no longer to function properly, the result can be migraines, sinus issues, and more.

Another problem relates to blood flow. Since the vertebrae in the neck are responsible for facilitating blood flow to the head, misalignment may affect how much oxygen certain parts of the brain are receiving. This can result in problems with things such as the immune system (leading to overreactions that are responsible for many allergies and sinus issues) or the pain-sensing portions of the brain (which can be a factor in conditions ranging from migraines to fibromyalgia).

So it becomes clear that sinus issues can be one symptom of a far-reaching problem with the nervous system. So how can you approach this problem from a new angle, one that may result in both immediate and long-term benefits?

Upper Cervical Chiropractic and Sinus Pressure

Upper cervical chiropractors specialize in adjusting the C1 vertebra. The process starts with precise measurements of the atlas taken using diagnostic imaging. There will also be a physical examination. Combining the results of these tests, the practitioner will develop a safe and gentle adjustment that is unique to you.

Because the adjustments of upper cervical chiropractic are so gentle (there’s no cracking or popping of the spine), it works “under the radar.” In other words, the body doesn’t sense a major movement and immediately start working back toward where it was. This allows atlas adjustments to hold longer, giving your body the time it needs to heal from damage that may have been caused by the misalignment. This is why many patients see both immediate results as well as long-term benefits from this form of care.

It also makes upper cervical chiropractic very cost-effective when compared to many of the traditional forms of sinus pressure care. Additionally, it is non-invasive, so it is definitely something to consider before having an elective surgery that may not even completely resolve your sinus issues.

To learn more, contact an upper cervical practitioner in your area to schedule a consultation. That will help you to determine if this subspecialty of chiropractic care is the best option for you. You may be about to take your first step on the path to natural sinus pressure relief.

Find An Upper Cervical Doctor in Your Areato schedule a consultation today.

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