I know there's probably been a lot of topics about this before, but my doctor presented me with this possibility today. After hearing all my symptoms, she told me that I sound more like I have migraines or cluster headaches than a sinus infection. I know nothing about migraines, including how they start and how they're treated. For those of you (if any) who have had experience with this, I would love any feedback. Have you ever developed migraines that were mistaken by yourself or your physician as sinus headaches? Here are my current symptoms:

- burning tenderness in the forehead, usually between the eyes, on either farthest side of the forehead, or both

- pain that is dull to mild during the day and flares up incredibly at night

- light fullness/pressure around the eyes; feels kind of like my eyes are a bit heavy from exhaustion. *no vision problems*

- occasional pressure in the ears, as if they need to be popped; feeling is worsened after being in a moving vehicle for more than ten minutes

- tenderness/tightness on the top, back, and sometimes sides of the head (not as bad as forehead pain); also felt moreso on the right side than the left.

- tenderness in the nose and around the eyes (in all the sinus areas, pretty much); feels moreso around the right eye than the left.

- slight to mild sensitivity in upper front teeth that is not affected by hot, cold, eating, brushing or flossing

With my last sinus infection, I did not have any sort of drainage from my nose or mouth...and the same applies to my current condition. The only thing that really strikes me as being unrelated to a sinus infection is the flare-ups at night. As I type this, my head has begun to ache far worse than it was a couple hours ago. I am also considering the possibility of a dental problem...don't know what exactly, but I suppose it's possible. My oral hygiene is not horrible, but it's also not perfect.

In any case, my ENT put me on a very potent combination antibiotic (amoxicillin/clavulanic acid) and said if I see no improvement on this medication that I most likely am suffering from cluster headaches or cluster migraines and that I should see a neurologist to find out what to do next. At the very least, she told me that if I were suffering from something very serious like a tumor, cancer, abscess or so forth, my symptoms would be different. It doesn't help my pain go away, but it keeps me from having nervous breakdowns after hearing her say that. For the record, my family has no history of brain problems and I have never sustained any head injuries.

Edited out this last paragraph. I've been reading about cluster headaches while researching migraines and a lot of the symptoms sound like what I have. I'm crossing my fingers and hoping for success with the new antibiotics, but if not, I'm leaning toward the possibility of cluster headaches; it would explain the unilateral head pain.

I have been diagnosed with classic migraines and I am not sure if those are different from cluster migraines. Your symptoms do not at all sound like my migraine symptoms. Mine are as follows:

Blind spots appearing for about 15 minutes
Distorted vision in one eye (looks like rain running down your windshield when your wipers aren't on) for about 15 minutes
15 minutes of no symptoms
pain and pressure on the opposite side of the visual disturbances followed very quickly by nausea, vomiting and light and sound sensitivity.
A few hours later, as the other symptoms subside, I am left with a pressure type of headache which is really uncomfortable when I bend over, etc.
I am exhausted physically the next day, but the pain is gone

As I said, those are classic migraine symptoms. I know some people do not have the visual disturbances preceding the pain, but your pain does not at all sound like the type of pain I have. You might want to do an internet search specifically on cluster migraines and see if those are different.

I am going to share what I take though because who knows, maybe it will help you too.

I take Three Mortrin or Aleve and a Bendryl, with a Coke for the caffeine. That all seems to make the pain much more bearable and it eliminates the other symptoms, except for the next day exhaustion.

Good luck and let us know what you find out! You might also try taking a Sudafed or some other type of decongestant and see if that helps. If it does it is likely to be sinus related.

Nancy

Thanks for all the input, BioAdoptMom3. You say you suffer from changes in your vision - may I ask if you notice a change in the appearance of your actual eyes? I made a post in the Vision forum about my pupils being different sizes, and now I'm starting to wonder if it's related to my headaches. During the day my headaches are dull or mild yet constant pain, and from what I've seen my pupils are normal in size. At night, they pain gets noticeably worse and the pupil in my right eye becomes notably larger. It still contracts in the light, but it's larger. I've been looking for about an hour specifically for any correlation between unevenly dilated pupils and migraines or cluster headaches. I'm not having any vision problems, so I can't imagine it's a problem with my eye.

From what I've read (and seen, courtesy of medical diagrams), cluster headaches seem to center more around the eyes, whereas migraine pain takes up the whole side of the face and head. I feel pain more on the right side, but I do feel it on the other as well.

I started those new antibiotics today, so hopefully they'll help because I really don't want to go to a neurologist. I'm going to feel weird if I do need to see a neurologist because I'll be 300 miles from home by the time I'll be able to tell if the new meds are working or not. In any case, I shall keep you updated if anything comes up. All I know is I'm going to lose it if I get told it's anxiety (like when these headaches first started and I ran to the nearest emergency room thinking I was having a stroke).

Hi Dark Stranger,

I have been reading your post. I actually suffer from Cluster Headaches and have done for about 15 years. My symptoms are:
Pain around the eye (always on the right side) as if someone is stabbing it. My eye usually starts to water, terrible pain in my nose, pain in the neck and shoulder (again always the same side), I get very hot when I get these attacks, I feel very sick and usually have to throw up (sorry for sounding disgusting). Most of my attacks are late at night when I'm actually sleeping, I wake around 2-3 in the morning, the attacks usually last anything between 15 mins to an hour. I go back to sleep but can wake again to the same cycle around 1 - 2 hours later. I suffer 2 - 3 months like this and they can disappear as quickly for upto a year. I went to see a Neurologist who diagnosed me with C/H's. When I am in cycle of these attacks, I was prescribed Verapamil tablets, which once in the system, usually work. Also 02 has helped a lot of sufferers. Hope this helps. Any more info you need, let me know
Pain in my nose

I don't know about the changes in pupil size because I have never thought to look, but that may be interesting to do next time. Usually I get in such a state of panic when I start to have those migraine symptoms because I know what's coming that I cannot think to do anything else but take the medicine.
I think the PP might be on to something if your antibiotics don't work this time. You might want to consider cluster headaches. Let us know what happens.

Nancy

If a headache responds to an oral decongestant (such as Sudafed 60mg) plus inhalation of very hot water with a little eucyliptus oil added, it is probably sinusitis.

Try Advil Sinus, it can be extremely helpful

I think you really should do some research on trigger points. Trigger points in the masseter muscle can cause sinus pain and pressure. And trigger points in other muscles of the head and neck could also cause the other symptoms that you have listed. You can get rid of these yourself and the relief should be instantaneous.

I recommend the Trigger Therapy Workbook by Clair Davies but there other books and sources. Let me know if you have any questions.

My mom said she talked to my doctor today passing by in the hall at work, and Doc asked how I was feeling. My mom forwarded the following instructions to me from my doctor. I was told that if my current antibiotics do not have an effect that I need to start making a log of my head pain. I need to record when the headaches flare up, when they end, and how powerful they get. I could do this without needing a log book because my headaches get worse late at night and are far less painful when I wake up the next day. She also told me to cut out caffeine, which I doubt will do much of anything considering I don't drink much coffee or soda anyway (maybe a couple times a week). Unless I'm hallucinating (or was before), I notice my pupils are no longer different sizes.

Lucky427, I actually did try massaging the trigger points after reading about it from a body massage book (there was a section that dealt entirely with decongestion). I tried some of them, but all they really did was make my head hurt more...except for massaging the fingertips and toes, which yielded no results.

Dark,

Do you remember which areas you massaged? Also, if you just lightly massaged a trigger point as opposed to release it, it would irritate it and cause increased discomfort. To find the trigger point, you are looking for the spot in the muscle that RADIATES pain. Once found, you need to apply firm pressure aiming to produce about a 7 level of pain on a a 10 point scale. Hold for a full minute. You should repeat this process a few times a day. If the pain is from trigger points, the pain should go away after about three days. BUT you have to eliminate ALL trigger points. This requires some diligence to seek them all out.

Again to me, an increase in pain or a change in symptoms from doing massage is a good thing. As it indicates that pain is indeed coming from the muscles.

I still recommend concentrating on the masseter for sinus. You stick yoour thumb inside of your mouth all the way to the back and squeeze the muscle between your thumb and forefinger. If you feel pain from this, at the very least it means youve found a trigger point in that muscle. Let me know how it works.

Also, a non-trigger point little trick. To clear sinus, sometimes it works to press your tongue on the roof of your mouth towards the back. Hold for a second and alternate by pressing your forefinger on your forehead right in between your eyebrows. Repeat a few times. This vibrates the vomber bone and drains the sinuses. But hopefully your problem is trigger points and you dont need this anyways.

Also, that book sounds suspicious. Did it concern trigger points associated with myofascial pain syndrome and Drs. Travell and Simons. Firgertips and toes have nothing to do with pain in the head. If the problem is muscular, it would be caused by muscles in the head and neck. Those are the only ones that refer pain to this area. Specifically:
1) sternocleidomastoid (can cause sinus pain)
2) splenius capitis
3) semisplinalis capitis
4) zygomaticus (can cause sinus pain)
5) levator labii (can cause sinus pain)
6) frontalis
7) trapezius
8) temporalis
9) splenius cervicis
10) suboccipitlas
11) masseter (can cause sinus pain)
12) occipitalis
13) orbicularis oculi (can cause sinus pain)
14) lateral pterygoid (can cause sinus pain)
15) medial pterygoid
16) digastric

Check them all out to make sure that trigger points are not causing the problem. If these muscles are painful under pressure, then trigger points are at least part of the problem. Healthy muscle should not hurt.

I have had all of the symptoms that you complain about and have been doubtful about the diagnosis of sinusitis as well, but the clinic usually prescribes antibiotics and sure enough it helps. I also have migraines, but it sounds like you've got something else going on. Have you tried salt water drops to clean things out, or one of those nasal wash kits? Do you have allergies? Maybe it is causing chronic inflammation? I take Nasonex when I get these symptoms as well and it help to open up the passageways.

Lucky427, the chapter I spoke of on decongestion and massage dealt with trigger points on the face, the back of the neck, back and top of the head, in the index fingers and the middle toes. It also had something dealing with inhaling steam to decongest the sinuses. The authors were Lacroix, Seafer, Tanner, and someone else.

Ihaveaheadache, I've noticed that my head pain seems to be a little less powerful than it was before. Either the antibiotics are kicking in or whatever I have is going into remission. To answer your questions, I have not tried any of the treatments you mentioned and I no longer have any allergies. I used to be allergic to freshly-cut grass, which would trigger some lovely bronchitis. But I have gotten over that allergy and now I can take a clump of grass clippings and stick it in my face with no reaction.

I haven't had any caffiene for a few days and I don't know if that has anything to do with my symptoms or not. The headaches still flare up at night...earlier today my face didn't feel that achey. Right now, at 1:45 a.m., my head has begun to feel tight again and the top of my head feels achey as well, which is not a new symptom. I was wondering if my headaches were cluster headaches as opposed to migraines, but don't cluster headaches center around the eyes? I feel a slight bit of pressure behind and around my eyes, but not as much as I do in my forehead and the top and back of my head.

Edited to add: I spoke to a friend of mine today about my headaches, and she told me that she has a lot of the same symptoms I do - especially the pain in the back of the head and neck. She's had a headache every day for the past three years and her doctor told her she has chronic tension headaches and that they can occur even when you're having the most mellow day of your life. I was told in the emergency room three months ago I was having tension headaches...makes me wonder.

Anyway, no new news from my doctor.

That sounds EXACTLY like what Ive been going through for the last 2 weeks. I also thought it was a dental problem, because my back upper teeth hurt as I get the headache. My headache is always in the left top side. I went to the dentist, and everything was all clear. My Dr. thinks it is a sinus infection, but I don't have any real symptoms of being sick! I do have the feeling that my ears need to pop, but they wont. Every now and then, the headache pain will creap down to the front of my head.

Small unimportant update - my headaches are still not gone after two weeks of antibiotics. They feel like they've improved very slightly, but that could very well be due in part to me having more distractions being back in school. I've been laying off caffiene for the most part - I limit myself to one cup of coffee a week. I only noticed a difference when I drank my school's coffee - I felt like someone used my head for a croquet ball.

No new symptoms, which is always good. I still see the changes in my pupils - some days they're normal and some days they pupils are different sizes. *sigh* I really don't want to get an MRI, and I know my mother won't be too happy to know if I need one considering how much the test costs; I'm still on her insurance and she was screaming when I told her I was having headaches because she knows I'd get scheduled for an MRI. Aw well.

Thanks, everyone, for your advice.

Dark

I would strongly recommend seeing a doctor. Different sized pupils could indicate a serious condition. Let a doctor determine if you need an mri - not cost. You dont want to play around with your head.

best of luck to you

Lucky427,

I contacted a doctor one morning about my eyes because I was freaking out, and they told me that I would be feeling different and very noticeable symptoms if I was suffering anything serious. Also, I seriously have no idea if my eyes have always been that way or not - I just happened to notice it after reading something about a serious condition characterized by severely uneven pupils. I don't know if one pupil gets larger or the other gets smaller - from what I have read, different sized pupils can be a symptom of migraines. I've never paid much attention to my pupils, so for all I know I was born like that.

I'm not experiencing any vision problems, weakness, and so forth. I know my doctor told me I should get an MRI if the caffeine abstinence did nothing, but I probably will not be able to get it done until I go home again, which will be in a little less than three months. I almost don't want to get an MRI because I worry it is something serious at times. In any case, I'll update if/when I get the test done.

About 10 years ago I noticed my pupils were uneven, very noticable. Dr. had me get CT nothing showed up. I have noticed different meds will make it worse. When my sinuses are bothering me it happens. I was on zoloft once, it caused my pupils to do it all the time. I know I should get to the bottom of it
but I feel like if it was something really seroius, I would know after all these years.

Different pupil size could be genetic and completely harmless. It could also be due to a number of other not so benign causes. Uneven pupils could indicate compression of the optic nerve.

Im curious as to what "other" symptoms they told you could have or that you should look at for. Considering that you have had sever headaches for a while that seems like a significant symptom to me. Did they tell you this over the phone? Did anyone even examine you? I think it would be prudent to at least have a neurologist check you out much sooner than 3 months. Its probably nothing but Im sure i think its smart to at least to talk to a neuro. It sounds like your dr did recommend an mri, too. You should know already that cutting caffeine did not work - it doesnt take too long for caffeine to leave the system.

best of luck to you - i hope the pain goes away soon.

Lucky427,

Both my doctor and two ER doctors I spoke to told me that I would be feeling symptoms like nausea, dizziness, vision loss, fainting, memory problems, numbness or weakness in one side, loss of coordination, or personality changes if whatever is ailing my head was anything threatening or concerning. I told my doctor all my current symptoms over the phone and she told me I sounded like I had migraines or cluster headaches without examining me. I don't know if she wanted me to get an MRI when I go back home or to speak to a neurologist where I live (I go to school in a city 500 miles from home). I may call her tomorrow or Wednesday and just talk to her to see what to do from here now that I've seen caffeine abstinence has made no difference.

I do not know if the pupil size difference is genetic - I realize it could be due to a weakened muscle in one eye, I realize it could be due to migraines, and I realize it could be harmless or just the way the light happened to be hitting my eye when I looked at them. I can't imagine that my pupils would change in size like that every day - half the time when I look at my eyes in the mirror, they look fine. The other half the right one looks larger. I just looked at my eyes about an hour ago and they were normal.

I also notice when I push firmly in one particular spot on the right side of my head, I feel soreness. It feels like I've bumped my head, only I haven't. It doesn't hurt when I don't push down on it. I don't know if this is a symptom of tension headaches or migraines or whatever is ailing me, but I'll find out from my doctor back home when I speak to her again.

Anyway, thank you all for the replies. I will update further when I speak to my doctor or if I speak to a neurologist.

Cluster headache will not show up on an MRI or a CT or in any other diagnostic exam. You display the classic and I mean very classic symptoms of cluster headache symptoms.

There is little that can be done for you durring the cluster period other than to see if you can get someone to hook you up to pure oxygen for a good while to get the headache to go away and get started on a regemin of preventitives with an abortive which sadly for those of us with cluster is limited to zomig and imitrex but happliy Imitrex works great for me.

(You need the injection to you can get it when it starts and it is not cheap!)

I wad diagnosed for 2 months with a sinus infection before I was sent to the neuro and told that I don't have a sinus infection. If you smoke, QUIT, that only makes this worse as do all narcotic meds. NASIDS help and if you go to the ER for treatment, O2 and Toradol work best because with cluster headache one is a nasid and the other is just oxygen and it really works well for cluster. They may also give you sumatriptan if you mention diagnosis of cluster migraine as well as oxygen, it just depends on the ER doc and how up to snuff on headaches he/she is.

They will most likly try to give you Demerol or another narc med for pain, don't let them if you are truly a cluster migraine sufferer, it will hurt you worse.

Good luck
Brian

Dark -

sounds like you've found a trigger point (from your description it seems like your temporalis muscle).

While as I have I said (and it seems like you are doing) I definitely being cautious about checking for other symptoms, I am of the firm belief that most non-aura chronic headaches are caused by trigger points. I really urge you to check it out as it could likely be a CURE for your pain. It just requires you to put a little amount of time into understanding and fixing them. I just tried to look for the book you mentioned online and I couldnt find it. i really recommend the Clair Davies book. But if your more adventurous you could try the Travell and Simons textbook.

Ive written about trigger points a number of times on this site, and it seems that people have not been able to or willing to explore them. I promise that it is not that complicated and you do know quite quickly if they are causing the problem. If you (or someone else) is having trouble figuring out how to get rid of them (or if you have them) please please ask me questions.

A number of researchers in the field (university affiliated doctors) have estimated that 90% of chronic headaches are caused by trigger points/myofascial pain. The problem is that while I have not seen any literature challenging the concept most doctors and neurologists do not really understand the subject (though they have likely heard of the concept). Fortunately, it is gaining a lot of traction in a number of different specialities and more and more physicians are beginning to write and lecture on it.

Anyway, let me know if you have questions.

Hi everyone,

Lucky, I sat up and noticed when I accidently fumbled my way into this forum. Your talk on trigger points grabbed my attention. I have been suffering from myofascial regional pain for a year and a half now and with tension and migraines headaches, also with sinus infections and inflammation for years now. I bought the Clair Davies tigger point manual a couple of months ago and read it thoroughly. i have been diagnosed with fibromyalgia by new reumatologist 2 weeks ago. I believe I have myofascial regional pain on my left side and fibomyalgia. I have tried working on my own trigger points, as I am plagued with them and strongly believe a lot of my pain is the result of trigger points. I haven't had much success at getting rid of them. They seem to be very stubborn. What am I doing wrong. Any advice would be appreciated. P.s. Had a horrid left sided migraine today. Massaged my neck trigger points and those at base of skull and it seemed to alleviate the intensity of the pain slightly. Please help!

My migraines usually start by my being cold. Then my neck starts hurting. I get stabbing pains on either the right or left side of my head. My nose does get stuffed up but only on the side of the migraine. I get nauseous, sensitive to light, sound and smells. I need a dark quiet room to lay down in. Sometimes I vomit, sometimes I don't. I sometimes have blurred vision but not always, it depends on how bad the migraine is. I have a migraine right now. It's not real bad yet and I am hoping it stays that way. I just took 5mg zomig and fioricet about 15 minutes ago and am about to take a hot shower for my neck and then use cold water on my head afterwards. If it stops I will be able to continue on with my day, if it doesn't I will take another dosage of the same as above. After that I am "you know what" out of luck. I am out of Demerol and I don't take more than 2 dosages of zomig. I sure wish you luck. I think you need to see a neurologist to rule out migraines. Sounds like sinus to me but I am no expert on sinuses. Take care and feel better.
Diane

I also have tried the trigger points. No luck. I don't know about everyone else but for me.. I have tried everything I can think of and things that anyone would suggest. Anything to get rid of the pain. I doesn't matter at the time of the migraine..just so it's goes away. I've even considered going illegal at times. Though I don't want to do that. By illegal I mean smoking pot. I've heard it can help but I don't want to really go there....Yet!...Maybe I'm nuts and should do it anyway. I don't know :confused: Right now with this migraine I just might if I had some. Or not. Drives me nuts trying to figure this pain out and trying to come up with anything to stop it. I am sick to death of pills pills pills. But who isn't in our situation huh? Take care. Diane