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Suggest Treatment For Sinus Headaches And Ear Infection

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Posted on Mon, 12 Dec 2016
Question: I had these severe headache this fall. They started as sinus headache but nothing helped them . I was given antibiotics X2 and antihistamine for ear infection. The headache got so bad I would have rated them, on the pain scale, as an 8. I finally went to ER and I was put on a steroid. this help until the steroid ended. I had frontal XRays now and the Dr says ir my L. jaw that the problem. I had TMJ all my life but no real problems with it. I don't understand why the Dr didn't want to do an XRay of the left side of my face to make sure that the problem. I never had head ache before, other than a mild sinus headache. I do have TMJ but never had any real issues with it.
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

It would be nice if you could have added some more words on the characteristics of the pain, such as exact location and spreading, character (sharp, pulsating, constant etc), triggering factors, accompanying phenomena like locking of the jaw, nasal congestion, visual symptoms etc, anything. Otherwise I have to accept the colleagues opinion and address only the imaging issue. I understand your disbelief since you’ve had TMJ issues before but not of this intensity, but remember that with age all joints undergo degenerative changes and symptoms may worsen

Regarding the imaging, yes an X-ray might have been done. However the x-ray is not a conclusive exam. While it shows bone changes like fractures, it doesn’t provide much information about the soft tissue such as the cartilage disc inside the joint which may play a significant role in the symptoms. The same applies to the CT scan which is better than x-ray for the bones but doesn’t visualize soft tissue either.

For that reason if one is to study the issue in depth an MRI is the exam of choice. Not that it is always done routinely, when the cause is clear usually conservative methods are tried and MRI is done when those do not work and surgery is considered.

Given the description of very intense pain which was improved by steroids I would discuss with your doctor whether he has considered the possibility of a condition called temporal arteritis. It is an inflammation of blood vessels which causes pain typically in the temple area but may spread, may involve jaw as well. It is treated with steroids which would explain the improvement. I am mentioning this diagnosis not because it is the only other possibility, but because it is a serious condition which may have serious consequences if untreated, for that reason it should always be considered in a new unilateral headache in the elderly (generally manifests after the age of 60), should be checked through palpation of temporal artery and some routine blood tests for inflammation.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (19 minutes later)
because of the ear infection that has been treated and seems to be OK. the headaches have varied. I do have sinus problems so it gets confusing for me. My forehead and eyes hurt and my checks. The principal pain after I take my antihistamine is the upper left temple my forehead. and my eyes are blurry. I only taken 1 500mg for any headache I have had. Now nothing seems to touch it. I have tried warm compresses with no results. My eyes are squinted when I have the headache. The pain is worst in the morning and if lucky decreases in the late afternoon. If it TMJ I would expect it to be worst at night after I have eaten all day.

500mg ASA in the past for head aches
doctor
Answered by Dr. Olsi Taka (4 hours later)
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information.

As you yourself say your prior history confuses things a lot, you have a history of sinus issues, ear infection and TMJ issues which all can cause pain in the forehead, face and temples which makes evaluation a little difficult.
The fact that the pain is worst in the morning doesn't go against TMJ disorder, it is common for it to be more pronounced in the morning. It is a phenomenon present in most types of joint problems where the joint is stiffer upon awakening and warms up later on. The distribution is possible as well as in time inflammation involves the facial and skull muscles, myofascial pain. So it remains a valid hypothesis.
The temporal arteritis which I mentioned before is something which must be discussed with your doctor, the high intensity of the pain you describe is more fitting with that diagnosis. As I said some blood tests for inflammation are necessary, perhaps they were done in the ER, should discuss that possibility with your doctor, review the tests and reports if you're not sure.
In terms of treatment if temporal arteritis is excluded, while ASA is fine I would try also other anti-inflammatory medication like Ibuprofen. In addition a muscle relaxant like a benzodiazepine may be tried.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (21 hours later)
I understand but my jaw does not hurt but what hurts is the temple area my eyes and my forehead. My face muscles did go numb yesterday afternoon which reminds me of a year ago when a dentist gave me a shot to numb my face and it took days to get my face back to normal. that was like the TMJ
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Read below

Detailed Answer:
If the symptoms do not involve the temporomandibular joint at all, nor the temporomandibular joint, then you do have a point, TMJ disorder without pain, or other symptoms in that area is less likely.
The distribution of the symptoms in that case would point more towards sinusitis or towards temporal arteritis which I have mentioned several times by now. If sinusitis is excluded by your doctors and blood tests for inflammation exclude temporal arteritis, then I would suggest an MRI to exclude some rare cause such as a vascular malformation or tumor compressing the trigeminal nerve which supplies the face. If the pain is on both sides though MRI should result normal, am suggesting it more as a precaution.
In the meanwhile if non-steroid anti-inflammatory medication like Ibuprofen doesn't work I would start preventive medication, choosing amitriptyline as it is a medication which is effective in most types of headaches. A muscle relaxant for a short period may be considered as well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3673 Questions

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Suggest Treatment For Sinus Headaches And Ear Infection

Brief Answer: Read below. Detailed Answer: I read your question carefully and I understand your concern. It would be nice if you could have added some more words on the characteristics of the pain, such as exact location and spreading, character (sharp, pulsating, constant etc), triggering factors, accompanying phenomena like locking of the jaw, nasal congestion, visual symptoms etc, anything. Otherwise I have to accept the colleagues opinion and address only the imaging issue. I understand your disbelief since you’ve had TMJ issues before but not of this intensity, but remember that with age all joints undergo degenerative changes and symptoms may worsen Regarding the imaging, yes an X-ray might have been done. However the x-ray is not a conclusive exam. While it shows bone changes like fractures, it doesn’t provide much information about the soft tissue such as the cartilage disc inside the joint which may play a significant role in the symptoms. The same applies to the CT scan which is better than x-ray for the bones but doesn’t visualize soft tissue either. For that reason if one is to study the issue in depth an MRI is the exam of choice. Not that it is always done routinely, when the cause is clear usually conservative methods are tried and MRI is done when those do not work and surgery is considered. Given the description of very intense pain which was improved by steroids I would discuss with your doctor whether he has considered the possibility of a condition called temporal arteritis. It is an inflammation of blood vessels which causes pain typically in the temple area but may spread, may involve jaw as well. It is treated with steroids which would explain the improvement. I am mentioning this diagnosis not because it is the only other possibility, but because it is a serious condition which may have serious consequences if untreated, for that reason it should always be considered in a new unilateral headache in the elderly (generally manifests after the age of 60), should be checked through palpation of temporal artery and some routine blood tests for inflammation. I remain at your disposal for other questions.