CT scan

16 October 2018

Can we Avoid Pointless Procedures for Sinus Congestion?

Researchers continue to express concern about incorrect diagnosing of sinus congestion. And the situation is more serious than you may think, because patients continue to take medications and undergo tests that may not be necessary.

A recent article in The American Journal of Otolaryngology again points out some of these issues. (By the way, otolaryngology, believe it or not, is an abbreviation of otorhinolaryngology, which refers to treatment related to the ears, nose, throat, head and neck.)

Sinus pain? Migraine? The article is about the treatment of rhinosinusitis, also known as sinusitis. The authors state: “Treatment of rhinosinusitis (RS) is one of the leading reasons for prescriptions of antibiotics, although they often fail to provide symptomatic relief.” (see abstract: Update on the diagnostic considerations for neurogenic nasal and sinus symptoms: A current review suggests adding a possible diagnosis of migraine)

Our modern concerns about the use of antibiotics aside, we should already know that something is wrong when they often don’t even alleviate the symptoms.

Previous research has suggested that most of the time the diagnosis of sinusitis is wrong, and that the culprit is actually migraine. The report clarifies this in further technical detail:

One explanation is that … Midfacial pain and pressure with rhinorrhea and nasal congestion do not represent an infectious, or even inflammatory, condition within the sinus or nasal cavities, but a mirage that is best treated as a migraine variant.

Notice the symptoms that could be from a migraine attack:

midfacial pain (sometimes referred to as “midface migraine”)
midfacial pressure
rhinorrhea (nasal cavities full of mucus, aka runny nose)
nasal congestion

These are not uncommon migraine symptoms.

To make matters worse, many patients who do not find relief with antibiotics also submit to a CT scan – radiation which increases their risk of cancer.

To add to the challenge yet again, patients often come to doctors insisting that they have sinusitis. As the researchers affirm in this report, doctors should seriously consider asking more questions before prescribing drugs that won’t help (this includes not only antibiotics but also nasal sprays) or scans that aren’t necessary.

If you’re feeling congested and have a headache, take a closer look at your symptoms.

For quick information to share with a friend, see Sinus Headache – Probably Migraine.

21 March 2014

Headache Patients: Stop getting your Head Scanned!

James Discoveries & Stats, Tips 5

You have a horrible headache. Maybe it’s the worst ever. Or maybe it’s accompanied by strange symptoms. Is it serious? Deadly? Better get a scan to check it out…

Wait! Not so fast. Getting a CT scan (computed tomography scan) or an MRI (magnetic resonance imaging scan) might sound like a good idea – “better safe than sorry” – but it could do more harm than good.

Thankfully, doctors are being educated about when to use and not use scans. But there are still doctors who are quick to use them – and even patients that demand a scan when it’s really not needed.

The guideline is simple, really. Scans should only be done when there is a good reason to suspect that something will show up – something related to the headache symptoms the patient is experiencing. That includes very few headache patients.

So what’s the problem? Here are some reasons why scans should usually not be done.

CT Scans: Radiation. This is the easy one. Recent studies have once again raised concerns about the link between CT scans and cancer. Don’t expose your body to radiation unless you’re sure it’s necessary, and the benefits outweigh the risks.
CT/MRI: There’s often a better way. The doctor can often use a better, more accurate method to find out what’s wrong. Just because these are well known methods, doesn’t mean they’re the best. And just because they find nothing doesn’t mean there’s no physical problem.
CT/MRI: Time and expense. Admittedly, the expense is often what drives concerns here. As patients, we’re in favour of methods that accurately diagnose the problem – no matter what the expense. On the other hand, when time and money is being wasted on a method that won’t help, there’s a problem. Yes, it is an issue for all of us when money is being wasted on unnecessary scans. Besides, your time is valuable, right?
CT/MRI: The last issue is the danger of unnecessary treatment. Here’s how it works. You have one of these amazingly accurate scans, and your doctor finds “something wrong”. We all have “something wrong” with us, but many of those things never lead to any symptoms. This “something wrong” your doctor finds leads to treatments, maybe even surgery. All of this does harm to your body. But does it solve the problem?
This is a huge issue right now, because so many tests are available. Statistically, many people are receiving unnecessary treatments and surgery, leading to more complications – when the “something wrong” wasn’t the thing causing the symptoms in the first place.

In short, even “safe” scans like MRIs (although even there accidents happen), and other tests such as EEGs, can lead to more problems for you when they’re used “just because”.

What should I do?

If your doctor recommends a scan, ask why. If she can’t give you a very specific answer, but just wants to “cover all the bases”, get a second opinion.

If a friend or family member is pressuring you to have a scan, send them to this post. 🙂

I’ve been there – it’s tempting to get every test possible, especially when you’ve spent months or years trying to find a solution. But for most of us, these types of scans just mean spending more time on the wrong thing.

MRI and CT scans are wonderful tools that have saved many lives. And yes, in a few headache cases they are a big help. We should be very thankful that they’re available. But let’s use the tools wisely.

Why some people don’t recognize post-concussion syndrome symptoms

James Information, Tips 5

Sometimes it can be challenging to diagnose post-concussion syndrome symptoms. And without a proper diagnosis, proper treatment can be hard to find.

As we’ve mentioned before, a concussion is actually a form of brain injury. To say “It’s just a mild concussion” as if it won’t have any lasting consequences is a misleading.

Symptoms of post-concussion syndrome (PCS) can vary. The common ones include headache, dizziness, fatigue, insomnia, and anxiety. There are also rarer symptoms such as hearing loss, impaired judgment, and trouble speaking. Here’s more on post concussion syndrome symptoms.

But here’s the problem. First, it’s not easy to just do a test and find out if you have PCS. Yes, your doctor may call for a CT scan, and that may help with he diagnosis. But it may not confirm that you have PCS.

Second, as you may have noticed, many of these symptoms are common in other types of headache. PCS can look very much like migraine, or like tension-type headache.

So how can you help your doctor properly diagnose your symptoms?

First, your doctor will want to know how things have changed and when they changed. Symptoms like these will probably appear within a few days to up to four weeks after your injury. Thankfully, the symptoms usually do go away fairly soon, especially if you can get to a doctor and get them diagnosed early on.

Your doctor will also need to know your medical history. Other conditions and diseases may be impacting your symptoms – things like migraine, depression, insomnia, and so on.

So do pay attention to symptoms and timing as much as you can while you’re preparing for your visit to the doctor. Your doctor will ask you some questions and may call for some tests. Treatment can involve several different things depending on your symptoms.

6 February 2013

“Just Migraine” (trust me). Or – Brain Tumour?

James News 2

Here we go again. Another patient diagnosed with “migraine” – but let’s not check too carefully.

Kian Jones was a school boy who started experiencing symptoms familiar to many migraineurs – vomiting, vision problems, and headache.

Three times Kian was taken to the hospital. It’s just a “stomach infection” was the first diagnosis. But when symptoms didn’t go away, the new diagnosis was “migraine”.

How carefully was Kian checked out? Not very.

Kian’s mother Sabina wasn’t convinced. She started searching online – and discovered that patients were often checked out a lot more carefully at the onset of new symptoms like her son’s. For example, a CT scan was often called for.

She urged doctors to call for the scan.

And it was discovered that Kian had a brain tumour.

Thankfully, and thanks to Mom, Kian is now getting proper treatment. He is now recovering and back in school.

Now before we’re too hard on the doctors, we do need to remember that brain tumours are rare, and migraine disease is far more common. We don’t know all the details of his symptoms. A CT scan is not always called for – it does depend on the symptoms a patient has.

However, there is a continuing concern that doctors in general seem to be far too quick to “write off” symptoms as migraine. They won’t bother to diagnose the type of migraine (treatments vary depending on the type), and they won’t bother to rule out other conditions that are increasingly likely as symptoms progress.

Symptoms of brain tumour (if there are any symptoms) can be exactly the same as migraine (especially certain types of migraine). Seizures are more common with brain tumour than with migraine. But symptoms such as headaches, changes in behaviour, nausea, changes in vision/smell, problems with coordination – these are all common in both.

One possible difference is that with tumour symptoms may develop more gradually. Symptoms will increase over time, instead of coming powerfully and then disappearing as they sometimes do with migraine.

This video from the Cancer Council in Australia will help you think through some of the symptoms of brain tumour.

via: Mother saves son’s life after Googling revealed he could have a BRAIN TUMOUR not simply ‘migraines’

30 January 2013

Sex Headaches

James Information, Medications, Tips, Treatments 0

Orgasm headaches or sex headaches are technically called primary headache associated with sexual activity. But that should only be after careful tests are done – as soon after the headache as possible – to rule out more serious (in rare cases life-threatening) causes.

This graphic is a reminder to see a doctor right away, and that treatments are available. Read more about orgasm headache here.