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What does severe headache,nausea and light-headedness indicate?

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Hello, I am 21 year old male and as far as i know i am in decent health. The last month my over all health has declined quite a bit. I have been having daily headaches with occasional nausea dizziness and i am usually quite fatigued all day.Sometimes it is so bad i feel weak and almost faint.The pressure
Pressure ulcer
seems to almost get stronger when i walk and have to do phisical activity. The headaches are lower head
Head injury
Head and face reconstruction
Head lice
Indications of head injury
Radial head injury
and neck
Cervical spondylosis
Herpes zoster (shingles) on the neck and cheek
Irritated seborrheic kerotosis - neck
Lymph tissue in the head and neck.
Melanoma - neck
Neck lump
Neck pain
Neck pulse
Neck x-ray
Oral cancer
Spinal injury
Pressure ulcer
that starts mid day and usually last in tell the day is done. I am uninsured and recently bit the bullet and paid out of pocket to see a general practitioner. A over all phisical was performed blood pressure
Pressure ulcer
was normal. Throids felt normal. But upon inspected my nasel cavity the doctor sed my sinuses seemed inflammed and i had post nasel drip. She diagnosed it as Sinusitis with no evidence of bacterial infection. And prescribed me Albuterol for my asthma, an antihestimine for my allergies and nasonex for my sinuses and sed that that the combination should clear up my sinus problems and hopefully alleviate my headaches. But as a precautionary step She ran blood test for HIV/AIDS HEP A/B/C a liver panal kidney panal and a thyroid panal and white blood cell count she also checked my blood suger. All test apparently came back normal.

It has been almost a month with this treatment and my symptoms have not improved. The headaches are still there and are getting worse with phisical activity the fatigue feels so bad sometimes it takes effort for me to walk even a few blocks and then i feel extremly lightheaded and faint.

The only thing my doctor could recommend is that i should get an MRI and CT scan. Which uninsured will be hard to pay for.

I would love to hear your expertise on this.

Also rather Asthma or Allergies could cause these symptoms.

Posted Tue, 17 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 11 hours later

Thank you for your query.

1. Sinus headaches usually worsen during the day as the maxillary sinuses fill up during the day. This is because the openings of the maxillary sinuses are high up in the nose. On lying down the maxillary sinuses drain as a post nasal drip and the headache subsides. Frontal sinus headaches are the reverse. These headaches are easier to relate to the sinuses if they are unilateral or increase on bending forwards. Most headaches worsen on walking, physical activity and exertion.

2. The sinuses have a vast surface area and hence with the slightest infection and inflammation the toxins are absorbed easily into the blood stream and cause the nausea, dizziness, weakness and fatigue. The post nasal drip causes acidity and reflux.

3. Assuming that your underlying condition is allergy, do you have sneezing and watery discharge (rhinorrhea) and nasal obstruction? Do you also have aspirin sensitivity? Asthma and sinusitis are related and treating the sinusitis relieves the asthma to some extent.

3. You should start a newer generation anti-histamine (such as levocetrizine or rupatadine) and an anti-leukotriene (such as montelukast) once a day. Instead of Nasonex, switch to budesonide, fluticasone or ciclesonide nasal spray. Start regular steam inhalation through the nose and mouth for 10 minutes at a time. Get your physician to prescribe these for at least two weeks and check the response. If you do not respond, the headache does not reduce or if steam inhalation makes you feel worse then you probably have significant nasal obstruction or a DNS (deviated nasal septum) or hypertrophied turbinates.

4. It is difficult to see the sinuses on anterior nasal examination as they are surrounded by bone and their openings are very small and usually hidden. The gold standard investigation is a plain CT PNS (Para Nasal Sinuses) on a multi slice machine. This can wait as usually at your age there should be nothing major.

5. There are many causes of headache which can be ruled out on detailed history and examination. Try and describe these in detail. Ideally an MRI or MRA is done for headache that does not respond to medication. Do you ever take medication for your headache or doe it subside on it's own? Besides sinus headache, tension headache and migraine should be ruled out.

Awaiting your reply,

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