I just wanted to let you know that I just got back from having a CT scan of my sinuses. I still have to see my doctor, but the technician told me that it was a good thing I got the scan done. The images do indeed show a lot of asymmetry in the sinuses, as though some are extremely blocked up. I still do not know if this is indeed the major cause of all my dizziness over the past five months, but I can't help being excited. I have had dizziness in the past from a sinus infection, but not nystagmus, nausea, depression, fatigue, and the other extreme stuff I've been dealing with lately.
If this is indeed the culprit, then it is a huge lesson to me that we must be our own best advocates! The doc didn't think I had an infection at all (and one course of antibiotics & nasal spray had no effect), but I requested a scan to make sure. I know this may only be part of the problem...I guess I'll find out more soon after I start some kind of treatment.
that's great news it would seem you have taken a large step in getting to the bottom of this. My advice is always keep pushing for answers. My experience tells me doctors don't know everything. Keep going now the ball is rolling.
It's pretty well accepted now that a sinus infection cannot directly cause dizziness; however, a sinus infection can wind up the migraine process which could then cause dizziness. So indirectly it's possible, but it's not the root cause.
Well, I understand your skepticism; often headaches are attributed to sinus when they are migraine. I probably have a migraine component going on. However, the CT scan didn't just show swelling in my sinus. The maxillary sinus directly above my root canal tooth is completely filled with infection, which has spread to the other sinuses as well. It is a well-known dental complication for bacteria from an abscessed tooth to spread into the adjoining sinus cavity, and my symptoms started the day after my root canal.
Re: sinus infection causing dizziness, I believe it can happen. It actually happened to me about 5 years ago. I let a sinus infection go without treatment and I got dizzy enough to go to the ER (after lots of tests they said it was the infection). I took the antibiotic and the dizziness went away immediately. The reason has something to do with the eustachian tube and draining, I believe. I guess a migraine mechanism could potentially be involved, but why shouldn't gunk in your ear tubes make you as dizzy as any other cause? It can't help the situation anyway.
Again, I have no idea if my dizziness will disappear with meds this time, but I'll keep you posted if it does. I just think it's important for folks to keep all their options open and keep seeking answers. Migraine can cause so many symptoms that we can ascribe all our symptoms to it, but in doing so it is possible to overlook other problems that should also be treated, and that's just as dangerous as not considering and treating migraine.
I thought I'd *paraphrase* some comments from David Buchholtz, MD for you. He's the guy from John Hopkins School of Medicine who wrote "Heal Your Headache".
The Myth of Sinus Headache
The mucous membranes that line your nose and sinuses are chock-full of blood vessels. When migraine causes the blood vessels around your head to become swollen and inflamed, its favourite targets include your nose and sinuses. The swelling and inflammation that result produces congestion, pressure, stuffiness, post-nasal drip and pain – or the so-called "sinus headache".
But you and the doctor don't realise it's migraine, but instead suspect allergy, infection or structural abnormality. There's no question an acute bacterial infection of an obstructed sinus cavity can cause pain, usually accompanied by fever and nasal discharge. But the notion that chronic, recurrent infection is a common basis for chronic, recurrent sinus-type headaches is nonsense. The true underlying mechanism is migraine. When you think your escalating facial pain is due to a sinus infection that then secondarily triggers a migraine, think again. The fact is that migraine is revving up progressively and is the single culprit.
The coincidence of a positive culture and pain too often adds up to the misdiagnosis of sinus infection, even in the absence of the expected hallmarks of infection: fever and pus-like nasal discharge. It is common for a misdiagnosis based on pain alone – pain that is actually due to migraine – without either clinical evidence of infection or positive culture results. In this scenario, when you improve on antibiotics, it isn't because the ABs are treating infection; it's because a flare-up of unrecognised migraine has settled down on its own. But the mistaken notion that infection was the problem is reinforced.
Radiologists inadvertently contribute to misdiagnosing migraine as sinus infection. They'll study images of the sinuses, including X rays, CT scans or MRIs, that show swelling of the mucous membranes or obstructed drainage. The radiologist misinterprets the findings as sinusitis which leads your doctor to assume you have an infection. Another common explanation for sinus headache is structural abnormality. The concept that a relatively stable structural abnormality can cause episodic headache stands on shaky ground.
Failure to appreciate the frequency with which migraine causes dizziness, unsteadiness and the spinning sensation gives rise to all-too-frequent misdiagnosis such as "inner ear infection" or "sinus infection" (which makes very little sense; it's a long stretch from the sinuses to the inner ear).
I interpret this passage as saying that head pain as well as sinus tissue swelling or blockages on scans are frequently misdiagnosed as sinus problems rather than migraine. To me, this is not saying that you cannot have a real bacterial infection in your sinuses, even if you are a migraineur.
It is my understanding that on a CT scan, the bone is white, air/space is black, and soft tissue is gray. If your entire sinus that should be black is gray, it clearly indicates the presence of infection/pus, etc. I think that obstruction and swelling issues have a different appearance on the scan.
I'm not a fan of leaving bacterial infections--especially those in the head-- untreated, so I'll be treating this one. Only time will tell if it's linked to the other symptoms.
He does say that infection most definitely can occur. In fact, in another passage he says that the swelling caused by migraine can make you more susceptible to infection (note: a true bacterial infection should produce fever and nasal discharge). And in your case I'd probably be treating it this way too as a precaution, but the take-home message from all of this is that even if it is an infection, it is migraine occurring with it or as a result of the infection which is behind the dizziness according to the top brains in the field. That's what the evidence reveals. So here's my guess: you either have a migraine episode going on which attracted a nasal infection; you have a nasal infection which kicked off migraine; you have both an infection and migraine and neither are related; you do not have an infection and it is all migraine.
Certainly is a nasty piece of work! Hope you feel better soon and are able to sort out whatever it is going on in there.
I'm starting to wonder what I'll do about the St John's Wort now. It is definitely causing a major hit on my libido, I feel like I'm putting on weight again just by looking at food, and my headaches are far worse without any triggers being present. What a bore.
Thank you for sharing your thoughts on this. It seems very likely that the infection came from my abscessed tooth (it was cracked from grinding--not decay!), as its roots extend right into the infected sinus cavity. I've been taking Culturelle to prepare for the onslaught of mega antibiotics--all effective drugs seem to come with a price! It sounds like St. John's Wort can as well--I wonder if you are allergic to the plant itself and that that is causing the headaches? I'm still taking a low dose of 5htp. I really think it reduced my headaches, but I'm curious in what it will do long-term. Maybe it could be an alternative?
My initial diagnosis when I was first sick was sinus infection. When I wasn't getting better from antibiotic and was progressively getting worse I needed to seek out more opinions and wound up with the vestibular disorder diagnosis. During that initial period though I had a CT scan of my sinuses which did show chronic sinusitis on one side. I have always had problems with congestion and am basically stuffy year round.
In the end I was able to recover without dealing with the sinuses, but it was going to be the next thing I was going to try. I have a deviated septum and so I was going to try to surgically repair that and see if clearing up my sinuses could help the dizziness. I think it can be a cause of dizziness for some people, just not as common, especially for long term dizziness.
I am curious about what chronic sinusitis looks like on a CT scan...do you happen to know? I also have a deviated septum. I wonder if that is very common? Anyway, I've had allergies in the past, but not really chronic sinus problems. I think I'm experiencing an acute illness, but it has gone on a while because it was never treated. The doc is treating me like a chronic sufferer with lots of meds. He said the next option would be surgery or IV antibiotics! I was rather surprised, but I think the infection just looked bad.
Anyway, I've just started treating it, so we'll see. It's frustrating how so many things can cause dizziness!
I just found some research that discusses how isolated headache and facial pain or pressure were less reliable predictors of a sinus infection (verified by CT scan) and typically have another cause (ie migraine). Better predictors of a sinus infection are fatigue, sleep disturbance, nasal discharge, nasal blockage, and a decreased sense of smell. Tooth pain is another good indicator.
This is interesting to me because from the beginning of this problem I've had insane fatigue. I would try to do the laundry and I would have to lie down for an hour. I attributed it to an inner ear problem and processing data at first. I also had the sleep disturbance big time and some other stuff, but the fatigue part is interesting to me. I kept asking my docs about it and they couldn't explain it.
Hi, guys--
This is interesting to me because from the beginning of this problem I've had insane fatigue. I would try to do the laundry and I would have to lie down for an hour. I attributed it to an inner ear problem and processing data at first. I also had the sleep disturbance big time and some other stuff, but the fatigue part is interesting to me. I kept asking my docs about it and they couldn't explain it.
I think deviated septum and chronic sinusitis are definitely connected- the blocked side collects gunk and an infection can stay active there. I've basically been told that I'm going to keep getting them till I get it fixed.
Fatigue is soooo connected to vestibular disorders too though. When I first go sick, if I overdid it (and of course I would never know how much was too much till it was too late) I would wake up the next day and be so fatigued that I literally could barely move my limbs. It was like I woke up weighing 500 pounds and couldn't move the weight. Over time the fatigue improved.
My fatigue from my sinus problems are more of a general low energy, I have to do a lot of exercise and stay active to keep my energy up. Also, I wake up tired every morning, never rested, and I think this is from not breathing well all night.
Everyone's experience is so different, but I wanted to share mine. When I asked the doc about fatigue early on he asked me if I was depressed, that that could cause fatigue. When I denied being depressed he said it was a common complaint with vestib disorders but he didn't know why.
I came across and downloaded (had to buy it) a very good talk by a doctor James U. Adelman. He is at the Headache Wellness Centre in Greensboro, North Carolina. His talk was directed at medical professionals on how best to treat migraine with meds. He also gave a summary of what migraine is and isn't. Some interesting points:
Only about one-half of patients with migraine are correctly diagnosed; of those diagnosed incorrectly, 42% are diagnosed as having sinus-type headache and 32% as having tension-type headache; a survey showed that 94% of patients who sought treatment in physicians’ offices had migraine (migraine is a type of headache that gets severe enough for patients to seek treatment); although tension-type headache is most common in the population.
Beta-blockers: all effective; propranolol most commonly used, but speaker prefers atenolol (inexpensive; can be given once daily, typically at night; fewer side effects). In studies, 45% to 60% of patients reported 50% reduction in headaches.
Calcium channel blockers: good for cluster headaches, not good for migraine; use doses higher than those for treatment of hypertension; may be effective if aura prominent feature; in studies, verapamil and amlodipine took up to 3 months to achieve effect.
Tricyclic antidepressants: low doses effective (for amitriptyline, doxepin, and imipramine, 50 mg/day); with amitriptyline and doxepin, end point is sleep without daytime sedation; side effects with amitriptyline and doxepin include weight gain; with nortriptyline and imipramine, all side effects less; when using nortriptyline, prescribe by generic name, which costs about $17/month (brand name [Pamelor] costs $575/month!); desipramine and protriptyline nonsedating and not associated with weight gain (protriptyline currently available only by brand name [Vivactil])
Other antidepressants: SSRIs and bupropion not effective in migraine; venlafaxine (Effexor) effective; in study, patients with anxiety benefitted from duloxetine; monoamine oxidase inhibitors effective, but have numerous side effects. Surprisingly, Cipramil (citalopram) did work for me although perhaps the SSRIs are more effective for vestibular migraine.
Neural stabilizers: previously called anticonvulsants; divalproex (Depakote) and topiramate FDA-approved; both have significant side effects, including weight gain, hairloss, and fetal neural tube defects; in study, only 36% of patients responded to gabapentin.
Alternative treatments: riboflavin—in small study, 59% of patients responded; magnesium—should be effective; known that patients with migraine have low levels of magnesium in brain; shown that intravenous magnesium stops headache; feverfew—effectiveness not clear; coenzyme Q10—effective in some studies; butterbur—in study, efficacy "71%, but efficacy of placebo 59%; botulinum toxin type A (Botox)—no clinical profile; anecdotally, some large trial now under way.
That's interesting about the fatigue part...I guess the brain gets tired processing so much stimuli while trying to do all the work of the inner ear! So you have chronic sinus problems? I've heard they can be somewhat difficult to treat...I recently got a neti pot, which makes me breathe better than I have in years! Still, I'm not sure it really clears out all your sinuses--is it just the nose that it clears? Apparently, some docs think chronic sinus sufferers have fungal infections--seems to be an area of some controversy. Interesting stuff, though.
Scott--thanks for the update! I know I have a sinus infection, but how much this relates to the dizziness is impossible to determine right now. My plan is to continue treatment and perhaps do a few more tests; I haven't thrown out the MAV possibility...on the contrary, I know I get migraine headaches (although not really now that I'm taking the riboflavin & 5 htp). It's sure not easy getting to the bottom of this stuff, is it?
>>> although not really now that I'm taking the riboflavin & 5htp
Interesting to hear you're getting results with this. I have a bottle of B2 waiting to go. I might hit it now even though I'm in a moderately bad spot. When I'm like this, I'm cautious when throwing something else into the mix.
Definitely is a major mission cracking this. It feels like trying to open a safe by picking random combinations!
That's interesting about the fatigue part...I guess the brain gets tired processing so much stimuli while trying to do all the work of the inner ear! So you have chronic sinus problems? I've heard they can be somewhat difficult to treat...I recently got a neti pot, which makes me breathe better than I have in years! Still, I'm not sure it really clears out all your sinuses--is it just the nose that it clears? Apparently, some docs think chronic sinus sufferers have fungal infections--seems to be an area of some controversy. Interesting stuff, though.
Take care,
Violet
I do have chronic sinus problems. I tried the neti pot too but it didn't make much of a difference for me. I get relief for about 2 minutes and then its back to the usual stuffiness! I have been less stuffy and runny since getting pregnant. This surprised me because everything says it should get worse but I'm not complaining! Eventually I'll have the deviated septum repaired. In the end I don't think it affected my dizzies though.
Violet,
Have you tried the NTI device yet? Also, did your dentist give you an estimate? I was shocked to find out from one dentist who charges $1229 for one. Yikes! I'm ready to make one out of styrofoam or wax or something and call it a day!
Here's some info I found from that dentist about migraine and causes which I thought was helpful....
Vascular Headaches.
Vascular headaches include classic (migraine with aura) and common (without aura) migraine headaches, cluster headaches, and several other less common vascular types of headaches. Although vascular headaches are probably the most investigated, this entire category may comprise only 6-8% of all headache pain.
Symptoms of the Classic Migraine (migraine with aura) include:
-Initially, a unilateral dull ache
-Intensifying pain in a crescendo fashion
-Paleness or redness of the skin of the face
-The pain pulsating
-The presence of an aura (seeing "stars," photophobia, tunnel vision) before the headache starts
Symptoms of the Common Migraine (migraine without aura) include:
-Similar symptoms to the classic migraine
-Lack of a prominent aura
-Occasionally, the headache is bilateral
Traction-Inflammatory Headaches.
Although these types of headaches comprise only about 2% of all headache pain, these are generally caused by severe diseases and disorders. Examples are brain tumors, aneurysms, infections, and neuralgias. Symptoms vary and can't be neatly categorized. However, often the pain of headaches in this category is very severe, increases when the sufferer bends over or coughs, and may be accompanied by other neurological symptoms.
Muscle Contraction (Tension) Headaches. The most common type of headache is the muscle contraction or tension headache. It has been estimated that this type of headache accounts for 90 to 92% of all headache pain. Because this type of headache may vary from mild to quite severe in intensity, often its sufferers are misdiagnosed as migraine, sinusitis or even psychogenic (imagined) pain. The TMJ headache is a Tension type of headache.
The pain of muscle contraction headache usually starts in the forehead, temples or back of the head and spreads over the neck and shoulders. Sleeping difficulties are common: waking without feeling rested, restlessness and trouble getting to sleep. Those who clench or grind their teeth also develop muscle contraction headaches, especially during times of stress or during the night. When asking a patient to describe their pain, I often hear such descriptions as, tightness, drawing, band-like, or vise-like. Muscle contraction pain may last for hours, days, weeks or even months. Lastly, as with all pain problems, if you persistently suffer with headache and your doctor can't (or won't!) give you a reasonable answer, get a second or even third opinion. In many cases, especially with recalcitrant headaches and body-wide symptoms of pain, fibromyalgia may be a cause of part of the headaches, neck aches, and joint pains.
Thank you for all of this information! No, I have not yet gotten the NTI device. I think my dentist is charging something like $400 or $500, but then insurance will take care of all but $150 or so...I could be wrong, as this may be the estimate for the non-migraine device.
I have a headache right now, in fact! I think it's b/c I quit taking magnesium while I'm on the antibiotics. I didn't think the magnesium was helping me, but I can't deny I've had headaches the last few days whereas I was almost headache-free before changing my supplements. I sure wish they'd work on the dizzies, too!
I hope you are feeling better...sometimes I do think we need to just rest a bit, although I get blue when I just lie around at home. I hosted a big children's party yesterday and I thought I was going to lose it about halfway through...not sure what part was anxiety and what part was fatigue/dizziness--it all got mixed up & seemed so ridiculous--I get frustrated at not enjoying the usual things! Still, everyone else had fun & I made it through--hooray!
