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Medical Forum / Diseases and Disorders / Sinusitis / April 2007Distinction between migraine/sinus headaches
Hi everyone, it's been a little while, still a lifer though! Was just wondering on this issue: my doctor has sent me to a neurologist as he says, given the operation I had on my sinuses didn't work, and given the seeming presence of "triggers" for the headaches I've been having, eg chocolate, perhaps my pain is migraine, not sinuses. He's attributed breathing problems to reflux and I've been on Losec which has helped a little with these. Are migraine and sinus headaches very distinct from each other? If I have migraine does this mean I don't have sinusitis? And if not how would I know? Sorry if this is a silly question. I mean, I know from experimenting with diet that chocolate does cause me to have headaches, and my symptoms seem very like the classic migraine headache, pain is always in the exact same spot, it's a dull pain behind left eye, I feel weak during and after headaches etc. But I also know how every theory makes sense when you're sick and looking for a cure. > Hi everyone, it's been a little while, still a lifer though! > [quoted text clipped - 18 lines] > But I also know how every theory makes sense when you're sick and > looking for a cure. I have had many sinus triggered headaches, complete with vomiting that I would describe just as you have, except it's the right eye. In my case, I found the trigger; invisible mold in the bathroom near my bed. Is this a classic migraine, which I had when young and without sinusitis? The difference is that with the classic migraines, I spent a whole day or half a day lying in a dark, silent room before throwing up, then being weak, and the sinus ones always occur in the early a.m. in my case. They're very similar, but different. Both left me weak and drained for a day. Susan On 4/25/07 3:06 PM, in article 1177538794.616563.7870@c18g2000prb.googlegroups.com, "mr_lamouche" <RonanFitzgerald@gmail.com> wrote: > Hi everyone, it's been a little while, still a lifer though! > [quoted text clipped - 18 lines] > But I also know how every theory makes sense when you're sick and > looking for a cure. Migraine and sinusitis are distinct from each other. You can have one without the other . Occasionally you could have both. Common triggers of migraine are starting birth control pills, smelly cheeses, red wine. ? Chocolate? Gee, dark chocolate is ideal for preventing and treating pre-menstrual headaches. If you have migraine headaches a techinique that may work is hard shower to back of neck while turning head slowly from side to side - 4 minutes / day. Often trains the blood vessels not to be so spastic. > Hi everyone, it's been a little while, still a lifer though! > [quoted text clipped - 3 lines] > I've been having, eg chocolate, perhaps my pain is migraine, not > sinuses. Was headache the only symptom for which you had sinus surgery? If not, what has happened to your other symptoms? Did the sinus surgery relieve them at all? > He's attributed breathing problems to reflux and I've been on Losec > which has helped a little with these. I really wouldn't bother. 95% of the time, reflux has become a default trash diagnosis that they drag out when they don't know what's really wrong with you. (At least it's an improvement over calling you a hypochondriac, which is what they used to say before reflux became the new diagnosis du jour.) Don't get treated for reflux until and unless a gastroenterologist actually diagnoses you with moderate to severe reflux based on actual tests (gastroendoscopy, 24 hour pH monitoring, or upper GI series at least). Otherwise it's just a waste of money. Believe me. For mild reflux, you can buy Prilosec OTC at your drug store without a prescription and get the same benefit. If you have breathing problems, assume it's a respiratory cause until proven otherwise. What kind of breathing problems, exactly? Have you been tested for adult-onset asthma? Do you feel especially congested in the trachea (windpipe)? If so, that's likely sinusitis--infected PND is inflaming your trachea. Do you feel especially congested way deep in your lungs? If so, that could be adult-onset asthma or perhaps even bronchiectasis from multiple infections. > Are migraine and sinus headaches very distinct from each other? If I > have migraine does this mean I don't have sinusitis? And if not how > would I know? Sorry if this is a silly question. I think that a diagnosis of an illness should be based on a specific positive result from a specific test, not a default when the other tests are negative. Your ENT is sending you to a neurologist and shoving Losec into you because he can't find a sinus problem. Believe me, gastroenterologists don't like having ENTs invading their field with default diagnoses. I had consulted a gastroenterologist once for a default reflux diagnosis, and he told me to "tell your ENT to stay above your neck where he belongs" (his exact words). That doesn't mean you don't have a sinus problem. You had sinus problems, you have breathing problems, the surgery didn't fix it. The simplest explanation is that the surgery was a treatment failure, in which case you need a second opinion from another ENT. I would start there. I don't know what kind of sinus surgery you had, but a common problem is overly conservative surgery: The patient gets a septoplasty or maybe just turbinate reduction and the sinus trouble remains. I'm a big believer in the radical approach--Clean out every ethmoid and maxillary sinus, ALL OF THEM, and see if the situation improves. > I mean, I know from experimenting with diet that chocolate does cause > me to have headaches, and my symptoms seem very like the classic [quoted text clipped - 3 lines] > But I also know how every theory makes sense when you're sick and > looking for a cure. Not me. I'm still a big believer in Occam's Razor. It's served me well and faithfully in both my professional and personal life.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. According to the president of the American Headache Society, Dr. Fred Sheftell of the Stamford Headache Clinic, sinus headaches are a US phenomena--they don't ascribe to facial pain headaches as due to sinus congestion in Europe (according to him and other neurologists)--the headache specialists believe that most "sinus headaches" are actually migraine. Dr. Buccholz, from Johns Hopkins, wrote a book called "Cure your headache 1-2-3-", and he has a great section that describes how the very vascular sinus area will become congested during a migraine-- and will respond to pseudoephedrine. Apparently the Europeans don't market "Tylenol Sinus", "Advil Sinus" and other OTC sinus remedies. When I've had sinus infections, I've had localized pain in my sinuses, worse with bending forward, and tooth pain. I've also had protracted frontal sinus pain that my ENT attributed to some thick scarring in my nose that caused my septum to be irritated--it become much improved after a scar revision surgery. When it acts up now, I lubricate with bactroban, and it promptly resolves. So, the neurologists say there is no such thing as a sinus headache, it's all migraine, And there's a lot of truth in that--many people experience their migraines as pain behind an eye, or over the frontal area, but when you are infected--or obstructed--your face can hurt. Migraines are tricky: they can have many presentations: I have vertigo that is due to migraine, with an underlying nerve damage. When I had a sinus infection, I'd get a lot more dizzy. Occam's razor is a great concept: but people can have comorbidities, and sometimes the simple solution ignores the complexity of the situation. Judy > > Hi everyone, it's been a little while, still a lifer though! > [quoted text clipped - 68 lines] > Email: sdlit...@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. In cliincal practice we see lots of sinus pain. If its a vacuum the pain is very severe. If its inflammation the pain usually isn't severe, less than a toothache even though the nose is running pus. Easy to confuse a Migraine , Cervical Myalgia, Septal Impaction etc with "sinus pain." and of course you have shopping headache, mad at husband headache, premenstrual headache, etc. All in the head. Safe to say if not brought on following a flight, a severe throbbing headache with visual difficulties is probably not sinus headache. On 4/27/07 2:43 PM, in article 1177710207.627576.34310@n35g2000prd.googlegroups.com, "judy.n" > According to the president of the American Headache Society, Dr. Fred > Sheftell of the Stamford Headache Clinic, sinus headaches are a US [quoted text clipped - 96 lines] >> Email: sdlit...@earthlinkNOSPAM.net >> Remove the NOSPAM before replying to me. > Easy to confuse a Migraine , Cervical Myalgia, Septal Impaction etc with > "sinus pain." and of course you have shopping headache, mad at husband > headache, premenstrual headache, etc. All in the head. Safe to say if not > brought on following a flight, a severe throbbing headache with visual > difficulties is probably not sinus headache. Sexist, blithering idiocy. Susan Headaches are classified by the International Headache Society Classification: non of the Grossan headaches are recognized--I concur with Susan. Judy > x-no-archive: yhes > [quoted text clipped - 7 lines] > > Susan On 4/28/07 7:45 AM, in article 1177771533.308353.281620@l77g2000hsb.googlegroups.com, "judy.n" > Headaches are classified by the International Headache Society > Classification: non of the Grossan headaches are recognized--I concur > with Susan. > Judy Dear Judy, You don't see pre-menstrual headaches? Cervical Headaches? Septal Impingement Headaches? Come visit my practice, please. Or read my book. Sure I see premenstrual headache--it's migraine usually. Cervical headache can fit into the overlap between migraine and tension--as it's a continuum, most migraines have a component of neck pain associated with them. The latest AHS lecture I went to discussed how migraine/tension headache are a continuum, not strictly different entities. Septal impingment headaches--I have them myself, and my astute local ENT figured it out, but due to a frontal sinus mucocele, I underwent a possibly unneccesary surgery, years of post op infection, until my local ENT did a small revision that helped, and I lubricate when it acts up, I try to use the International Heachache Society Classificaton of HA when diagnosising HA. I also use wonderful references like Dr. Larry Robbin's Headache Text--a free download at http://www.headachedrugs.com It's Headache 2006-2007. An excellent reference Judy > On 4/28/07 7:45 AM, in article > 1177771533.308353.281...@l77g2000hsb.googlegroups.com, "judy.n" [quoted text clipped - 7 lines] > You don't see pre-menstrual headaches? Cervical Headaches? Septal > Impingement Headaches? Come visit my practice, please. Or read my book. On 4/29/07 7:19 AM, in article 1177856376.207768.274970@n59g2000hsh.googlegroups.com, "judy.n" > Sure I see premenstrual headache--it's migraine usually. The ones I see respond nicely to diuretic or dark chocolate, not migraine medication > Cervical headache can fit into the overlap between migraine and > tension--as it's a continuum, most migraines have a component of neck > pain associated with them. The latest AHS lecture I went to discussed > how migraine/tension headache are a continuum, not strictly different > entities. That's why patients with migraine respond to daily shower hard to back of neck and turn slowly to see who is behind you, side to side. This "trains" the blood vessels not to be so spastic. > Septal impingment headaches--I have them myself, and my astute local > ENT figured it out, but due to a frontal sinus mucocele, I underwent a > possibly unneccesary surgery, years of post op infection, until my > local ENT did a small revision that helped, and I lubricate when it > acts up, Septal impingement headaches are difficult. You really need to be sure of the diagnosis to avoid surgery that won't help. Strangest is that even under good local anesthesia when the impingement was moved, the patient announced, "My headache is gone." How could this happen under local? > I try to use the International Heachache Society Classificaton of HA > when diagnosising HA. I also use wonderful references like Dr. Larry [quoted text clipped - 16 lines] >> You don't see pre-menstrual headaches? Cervical Headaches? Septal >> Impingement Headaches? Come visit my practice, please. Or read my book. Several points: In my experience menstrual migraines can be very protracted and painful: chocolate can be a trigger. I use triptans, NSAID's, prophylactic meds as needed. I recommend a low tyramine diet. I never use diuretics. Avoiding migraine triggers is key, and if hormonal shilfts can't be avoided they can be anticipated and treated. Giving chocolate is like using excedrine migraine--it has caffeine in it, and can give some relief but has high potential for rebound headaches if used more than 3 times a week. The vasospasm of migraine is secondary to a depolarization of the brainstem: so I think that range of motion exercises are helpful, but for loosening muscle, not "training blood vessels to be less spastic". Third, I could see why septal impingement would respond to manipulation under local--it's a referred pain. Judy > On 4/29/07 7:19 AM, in article > 1177856376.207768.274...@n59g2000hsh.googlegroups.com, "judy.n" [quoted text clipped - 45 lines] > >> You don't see pre-menstrual headaches? Cervical Headaches? Septal > >> Impingement Headaches? Come visit my practice, please. Or read my book. Well, to be fair to my ENT, he only suggested reflux after doing several tests for allergies/asthma etc. I'm clear on all of those. And personally I think reflux is a good suggestion, the very first day I noticed breathing problems and this general condition, I'd just had a large bowl of ice cream. Also my breathing, in the periods when it's bad, always worsens in bed at night. I used to wonder why this was. Similarly if I'm driving the car I find the seatbelt seems to make my stomach go crazy. So I personally feel reflux is a strong theory. As for the operation, the ENT said it was a success, he said it went to plan and that the only issue was the lining of my nose was still inclined to swell, but he didn't really know why, put it down to non allergic rhinitis. So at that point I thought, well, not much more to do. In the winter afterwards I know I didn't have as much problems with mucous blockage and stuff, but I got the same headaches as before the operation, though there's often no mucous at all for me. What I do notice is I swallow a lot of what MIGHT be mucous, but the doctor who suggested reflux says this could be stomach acid. And it does taste sort of bitter and is always clear. Basically after a year or so thinking I definitely had sinus problems I've enough doubt and reflux plus migraines seems to make as much sense as sinuses. I mean, I got a CT scan before the operation which showed I had a badly deviated septum on the side of the head that I was getting the pain. But isn't it totally possible to have screwed up sinuses and not really be that debilitated by them? That they went looking for a problem with them and did the op but they weren't the root of my health problems? This is what I wonder now. > Headaches are classified by the International Headache Society > Classification: non of the Grossan headaches are recognized--I concur [quoted text clipped - 12 lines] > > > Susan As you know, CT doesn't always correspond to symptoms, and you definitely could have reflux as well as sinus disease. It hurts when your nose swells and your septum is impinged. Sometimes the answer isn't simple. It sounds like you're questioning the sinus surgery--right? Judy > Well, to be fair to my ENT, he only suggested reflux after doing > several tests for allergies/asthma etc. I'm clear on all of those. And [quoted text clipped - 48 lines] > > > > Susan On 4/27/07 8:20 PM, in article 59fsrmF2kv944U1@mid.individual.net, "Susan" <nevermind@nomail.com> wrote: > x-no-archive: yhes > [quoted text clipped - 7 lines] > > Susan Excuse me what is sexist about pre-menstrual headaches?? You don't believe they exist? You don't think its important to treat these ? Would you care to speak to the patients who do have them and discuss their management, or talk to the dozens that I have prescribed for? Yes, pre-menstrual headache can be mistaken for sinus problem because in some persons it is associated with nasal congestion. Worse of all, pre-menstrual headaches are very easy to treat if the diagnosis is made correctly. That's what the revised edition of my book is all about, making the correct diagnosis. If that is what Susan calls sexist, perhaps her views are "tainted". |
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