Hello ! I read your question and understand your concern. I would recommend a sinus xray and a full blood work for sinusitis first. As you refer he as a deviated septum and mucosal thickening, predisposing him for recurrent sinusitis, which can aggravate migraine. Another problem to take into consideration would be bulky pituitary, but it doesn t cause severe headache , more than visual blurring. I don t know dhe dimensions of the bulky pituitary, but it has to be really big to cause headache. If he were my patient I would treat him with Topiramate, if the tests for sinusitis result normal. Topiramate is a very effective treatment for migraine. If sinusitis is diagnosed he needs antibiotics also. Hope to have been helpful! Best wishes, Dr. Abaz Quka