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  1. Dr. Michael Zitney
    13 March 2012 @ 4:06 pm

    Great topic, James.
    Very challenging, even for most doctors.
    So many of our patients first come to our clinic reporting they get recurrent sinusitis; many even have a standing prescription from their family doctor. They go and fill it themselves, and within a day or two of starting antibiotics, their “sinus infection” is gone. Now they are even more convinced that’s what they’ve had! The problem is they may get this every month or two!
    You have clearly explained above that most of the time these are migraine attacks and a triptan would be more successful without the risks and side effects of antibiotics.
    The tricky part is (and I haven’t seen this written in any journal, but I’ve seen it so often in my practice) that this seems to happen to people who have really had a sinus infection or two, or even sinus surgery in the past.
    There seems to be a rewiring of the pain pathway back out to the front of the face when you’ve had sinus problems, that makes it easier for the pain signals from other causes (like migraines, neck damage, etc.) to follow the established pattern. The head and neck are particularly prone to “referred pain”; this is when a pain caused in one area is felt in another. The best example is when a heart attack causes pain down your left arm. There is nothing wrong with your left arm, you just feel it there. When you have pain in your head, face or neck, it may be caused by problems elsewhere.
    So when should you assume you have a sinus infection? If you have a fever, congestion, heavy green/yellow nasal discharge and feel like you have a cold or flu, you should talk to a doctor. As James wisely points out, this doesn’t mean you need antibiotics, but it likely means you do have a sinus infection and should be seen.

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