Atypical Migraine, Neuralgia, or Sinusitis

[Josh1313]

Hi all,

I am new to the board and have an interesting dilemma for you. I have been having headaches for over 3 months now. It all started in early February when I would awaken with a deep, aching type pain in the middle of my head. I attributed this pain to stress from work and took 2 Tylenol and went back to bed. When I woke up later, I was fine. This occured intemittently for about 3-4 weeks. One day, I awoke with the same headache and took the usual Tylenol but didn't feel better when I woke up later. It was this day that I first experienced this continuous headache I feel to this day. The headache was deep and aching and lasted the remainder of the day. Later that day, however, my pain changed. The deep ache was replaced with intermitten jabbing like electric pains that were hot and searing. They would come and go all day as much as 50 times or more a day. I went to my primary care doctor and he gave me acetominophen with caffeine because he wasn't sure what was wrong. That didn't help me so he ordered a CT scan of my head and sinuses. The CT scan came back that my head was fine but that I had ethmoid sinusits. The ethmoids are between the eyes. I was shocked because I had no congestion or cold symptoms. All I had was some excess post nasal drip down my throat. The doctor put me on an antibiotic called Tequin which did not help and then Augmentin which also did not help. I decided to go to an Ear Nose and Throat doctor for help and she tried some allergy meds fearing I might have allergies. I knew they wouldn't work and they didn't. My next appointment with her we went over my sinus films and she decided I needed surgery to fix a deviated septum and correct some drainage problems. I was so doubtful that a sinus problem was causing this kind of pain that was in my temples and the sides of my head that I decided to go to a neurologist for a 2nd opinion. I told the neurologist my symptoms included intermittent jabbing pains in my temporal area and I asked if sinusitis could cause this pain. He said no. So now I have doctors saying my sinuses are causing the headaches and a doctor who says no they are not. The neurologist says it is either an atypical migraine/migraine variant or a neuralgia. He prescribed amitriptilyne and it has not helped so far as I have been on it for three weeks.

So now I'm asking you folks for some advice. Do you think I have a sinus condition and should go ahead with the surgery? I'm afraid I'll have the surgery and still have the headaches afterwards. The ENT doctor couldn't guarantee surgery would help the headaches. Should I continue to experiment with different drugs with the neurologist? I'm so tired of being in pain all the time. The only time for the last 3 months I haven't been in pain is when I've been sleeping. My quality of life does not exist!

The way I see it I have a couple of options. I can either just schedule surgery with the ENT doctor and hope that works. Or I can continue to try drugs from the neurologist. Or I can get a 3rd opinion from another doctor - either a neurologist or another ENT doc.

What do you think I should do?

My symptoms again - Headaches for last 3 months. Everday headaches for last 3 months. Bilateral pain but not both sides at the same time. The pain shifts sides from day to day. Sometimes I will wake with a deep aching pain in the middle of my head. But the worst pain is a jabbing, electric stab in my temples. Sometimes I will feel a strong sense of pressure and fullness in my temples. Temples are very tender.

I'm 26 years old, male and in general good health except for these headaches that have made my life a living hell.

[mlgable]

You need to get a something straight here. #1 you have a documented sinus problem. This was documented via the x-rays. #2 you have a nuerologist who says this is not the cause of your pain and is trying amytripyline. First off it often takes a month before you see full results of headache prevention medication. When does your neurologist have you scheduled to come back to see how it is working for you? That should be soon since you will pass 4 weeks soon. When you go back for that follow up appointment you need to tell him what the medication is and isn't doing for you so he can take things from there. Now as for the ENT doc............you already stated that you have a post nasal drip problem so that is part of what the doc is looking to help correct by doing the surgery. Talk with the doc to see what she hope to accomplish with this surgery before you decide one way or the other. Do not just write this doc off as you have a documented sinus problem. Whether you do anything about it is another story. As for you primary care doc he tried to help you but you didn't stick with him long enough to give him a chance to help you. Many times with severe sinusitis you need to take long term antibiotics to take care of it. You seem to have had this for at least three months according to your post so it may take more than a quick round of antibitotics to get rid of this. Put all this info together and decide what you feel you need to do next but do not totally ignore the sinus problem because left untreated it could cause more problems down the road. I am not sure if just the sinus problems is the cause of your headaches but you do need to get that taken care of to eliminate that as a cause or even a partial cause of them.

[Josh1313]

Thanks for your advice mlgable,

I do have a documented sinus problem. You're right! But as far as taking the antibiotics for the short term that I did that was my primary care doctor's decision. He put me on tequin for 10 days then augmentin for another 10 days. He didn't tell me I needed to be on antibiotics for the long term nor did the ENT doc. She tried allergy meds like Flonase and Zyrtec when I knew I didn't have allergies. She told me the primary car doctor undertook the correct course of action.

I do have another appointment with my neurologist but not until early July. It will be my 3rd appointment with him. The second appointment I told him I felt some moderate improvement in the jab-like headaches I was getting but not helped to the degree I want to. So he increased the dosage of the amitriptilyne to 25 mg. I will wait at least a month to see whether or not the drug will work.

In the meantime I'm going to make an appointment to see my primary care doctor and ask what he thinks I should do. If he suggests surgery, I'll probably do it. If he says wait and see how the drugs the neurologist prescribe helps, I will. I don't want to write him off but every time I go to him it seems as if he writes me off and acts like nothing is wrong with me and I am a hypochondriac. I wish I was.

Originally posted by mlgable:
You need to get a something straight here. #1 you have a documented sinus problem. This was documented via the x-rays. #2 you have a nuerologist who says this is not the cause of your pain and is trying amytripyline. First off it often takes a month before you see full results of headache prevention medication. When does your neurologist have you scheduled to come back to see how it is working for you? That should be soon since you will pass 4 weeks soon. When you go back for that follow up appointment you need to tell him what the medication is and isn't doing for you so he can take things from there. Now as for the ENT doc............you already stated that you have a post nasal drip problem so that is part of what the doc is looking to help correct by doing the surgery. Talk with the doc to see what she hope to accomplish with this surgery before you decide one way or the other. Do not just write this doc off as you have a documented sinus problem. Whether you do anything about it is another story. As for you primary care doc he tried to help you but you didn't stick with him long enough to give him a chance to help you. Many times with severe sinusitis you need to take long term antibiotics to take care of it. You seem to have had this for at least three months according to your post so it may take more than a quick round of antibitotics to get rid of this. Put all this info together and decide what you feel you need to do next but do not totally ignore the sinus problem because left untreated it could cause more problems down the road. I am not sure if just the sinus problems is the cause of your headaches but you do need to get that taken care of to eliminate that as a cause or even a partial cause of them.

[globe]

sinuses as in block nose ??
me 19 , having migraine too , since as young as i can remember . really ****up eh .
i seen a doc before too and he advise me to go swim ragulary and my migrain would be fine . u could try if it is the same case. i'm also on medication , but only take them when i'm in pain

[Sister]

I've had sinus headaches for 28 years. Sometimes the antibiotics don't help much. Sometimes I think there's something wrong with my neck and it is causing headaches, but I KNOW I have allergies. What I would like to say to you (josh1313) is DON'T have sinus surgery until you try everything else first. And the other thing I want to say is that if there is a virus or bacteria in your sinuses, it causes ALL KINDS of weird and not-so-weird pain. I hope you get cured. And I hope I get cured someday, but actually, I've lost hope of that happening! Bye for now---