sinus headache

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.

10 June 2014

Hemicrania Continua: Is Melatonin an Alternative to Indomethacin?

James Discoveries & Stats, Medications, Treatments 8

If you’ve never heard of hemicrania continua, you’re already lost. If you have hemicrania continua, you know exactly what I’m talking about.

Briefly, for the fortunate ones who don’t have this condition, hemicrania continua is a constant one-sided headache which is often accompanied by watery eyes and congestion. It’s often misdiagnosed as migraine or sinus headache. For more quick info, see Hemicrania Continua Facts.

There are some unique things about this condition. For example, the headache is always one-sided. And although it may wax and wane, the headache is always there.

But for our purposes, the important thing is that it it treated with indomethacin, a non-steroidal anti-inflammatory drug (NSAID) (similar to ibuprofen). And this treatment always works. Well, mostly.

Although hemicrania continua always responds to indomethacin, dosages may vary and its effectiveness may change over time.

But there’s a worse problem – side effects. Stomach problems, ringing in the ears – and even more headaches, to name a few of the more common issues.

So although patients are encouraged to periodically try to lower the dosage (once they’re stabalized), the possibility of new treatments is very attractive.

Melatonin is one of the main alternative treatments for hemicrania continua. There are few other treatments, and even melatonin has been studied very little. This is mainly because this is such a rare disorder.

However, more and more patients are trying melatonin as a safer alternative to indomethacin. Some patients start taking melatonin and are able to phase out indomethacin use. The melatonin may be taken during the day (it’s usually taken before bed as a sleeping aid).

Researchers at the University College London Medical School are encouraging doctors to take this treatment more seriously, after describing the case of another patient who found relief with melatonin.

Melatonin is inexpensive and widely available. Although it’s considered generally safe, do talk to your doctor if you plan to take it for more than a few days.

16 October 2013

Child with Sinus Headache?

James Discoveries & Stats 0

My child has a horrible sinus headache – they’re flushed and sweating, they’re congested … their eyes are watering … and they have a runny nose. What should I do? Antibiotics? Nasal spray?

Not so fast. There is increasing evidence that your child may actually have migraine. And if you’re getting these symptoms, you may too.

One of the most common and notorious misdiagnosis is mistaking migraine for sinusitis. A study completed this year further confirms that – even in children – these symptoms could be tricking doctors into giving the wrong treatment. And the wrong treatment could do more harm than good.

This study out of the University of California was recently published in the journal Neurology. It included paediatric and adolescent patients who had actually been diagnosed with migraine. Most of them had more than one “cranial autonomic symptom”. It didn’t matter if migraine was chronic, if there was aura or not, or what age the patient was.

What are cranial autonomic symptoms? These are symptoms of the head that are not controlled by the patient. They could include things like:

Congestion
Runny nose
Watery eye
Flushing/sweating
Puffy eyelid, or droopy eyelid
A sensation of fullness in the ear

This study suggests that these may not be unusual migraine symptoms – but very common ones.

Now the symptoms tended to be one-sided, but that’s not enough to help doctors correctly diagnose migraine. Patients and doctors need to be more careful about tracking symptoms, being aware of the patient’s medical history, and asking more questions – maybe even doing more tests.

In addition, these symptoms could indicate other headache disorders, such as short-lasting unilateral neuralgiform headache attacks.

The wrong treatment could have a lasting impact – a longer period of time without improvement, and even harm from medications and antibiotics that was unnecessary. Because migraine attacks tend to go away in three days or less, many parents think that the nasal spray or antibiotic “worked”. In reality, the attack went away on its own (and probably could have gone away sooner with the proper treatment).

Headache is much more common in migraine than in sinusitis. Think twice before giving your child medications and especially antibiotics (which likely aren’t needed in sinusitis either). Get a second opinion, and watch symptoms carefully.

25 March 2013

Sinus Headache – Probably Migraine.

James Information 3

Sinus Headache - Probably a Migraine Attack.

Your “Sinus Headache” was probably a Migraine attack

Congestion, facial pain, feeling hot, watery eyes –
these are all common migraine symptoms.

The differences?
A migraine attack usually goes away within a few hours (up to three days). You may feel nauseous.
Sinusitis will last for days or weeks. You’ll feel sick, though probably not nauseous.

Other possible sinusitis symptoms:

Fever (not just feeling hot)
Yellowish/greenish mucus
Cough and sore throat

For more, read Sinus Headache â€“ Did You Really Beat It? and Are you getting sinus headache symptoms?

1 March 2012

Sinus Headache: Say NO to Antibiotics!

James Discoveries & Stats, Information, Tips, Treatments 1

There is increasing evidence that those who a diagnosis of sinus headache, or a self-diagnosis of sinus headache, should NOT be taking antibiotics. Why?

First of all, a number of studies have suggested that many – perhaps most – perhaps even 80%-90% – of these patients actually have migraine.

So chances are you should be taking migraine meds instead of sinus meds.

A study published in Neurology in 2002 (Lipton et al) looked at patients with migraine who also supposedly had sinus headaches. Patients were given analgesics, antihistamines, and/or decongestants for their headaches. About half were dissatisfied with these treatments.

These patients then took migraine medication for two of their "sinus headaches" – in this case, sumatriptan. Surprise surprise, 73% had pain relief within 2 hours. 45% were pain free within two hours!

Antihistamines, decongestants, antibiotics – all big business. But what if most were being given to the wrong people?

The misdiagnosis likely has to do with the high prevalence of congestion and other sinus headache symptoms in migraine. Many people don’t realize that congestion is common in a migraine attack, or even nasal discharge. And many doctors are confused as well.

But what if you’ve had a proper work-up, and you believe you do have a sinus infection? (More on how to differentiate between a migraine attack and sinus headache here) Chances are you should still say NO to antibiotics.

Most often, sinus headaches from an infection are due to a virus infection – and a virus infection will not be helped by antibiotics.

A recent study in the Journal of the American Medical Association confirms this in real life. 85 adults with uncomplicated acute sinusitis were given an antibiotic, and 81 were given a placebo. (see Author Insights: Treatment of Acute Sinusitis With Antibiotics Often Futile)

At 3 days, there was no difference between the groups in quality of life or symptom relief. At 10 days, there was no difference between the groups in quality of life or symptom relief. No difference!

In the USA, 1 in 5 antibiotic treatments is given to someone with sinusitis. That’s a HUGE number of people in one country alone getting a medication they don’t need, that won’t help them!

And those were patients who most likely really had sinusitis.

So let’s take the millions who are diagnosed with, or believe they have, sinus headache. Subtract most of them – they actually are having a migraine attack.

Now take the few that remain – should we give them antibiotics? Most likely not.

That’s millions of people with so-called sinus headache – almost all of whom should should NOT be taking antibiotics (or antihistamines, or decongestants…). And that probably means you, sinus headache sufferer.

In a world where we’re more and more concerned about the personal and worldwide impact of overuse of antibiotics, it’s time we cut those millions of prescriptions. If you’re not sure, do some research and be sure that you not only have a sinus infection, but an actual bacterial infection (not viral), AND that it’s worth it to take the antibiotics.

Unless you’re in that tiny minority, do yourself and us a favour – get a proper diagnosis, and if you need to take something that will actually help you.