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Suggest treatment for vasomotor rhinitis with sinusitis and migraine

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ENT Specialist
Practicing since : 2001
Answered : 2349 Questions
Question
Hi Doc,
My name is XXXX. I am a 51 year old male with a history of headaches and migraines since I was 8. I have had eye tests, ct scans and various tests throughout my life to find causes, but never really have had a good diagnosis other than cluster migraines, which I have been able to treat with acetaminophen and aspirin and more recently immitrex.
I have been tested for and know I am allergic to several types of grasses, and a few weeks ago found out it appears I am allergic to wheat, so I have been on a wheat free diet to see if this helps headaches etc...
My nose has run when I eat as long as I can remember, and 9 out of 10 mornings I wake up with stuffy sinuses on my left side and usually a low grade or stronger headache.
Finally, three weeks ago I had the most powerful strange headache/earache/shoulder, jaw and throat pain that began with a very sharp and strange sinus pain again on my left side. It was the middle of the day, which was uncommon, it came on fast, also uncommon, and lasted for hours until I killed it with immitrex. For the next three days, I continued to have the same headache/sinus pain and symptoms and finally went to the ER. The ER doctor gave me a referral to a neurologist who I saw the day before yesterday and he said I was having rebound headaches from all the pain meds. He told me to not take anything for two weeks, which I agreed to, but just broke my promise after a ten hour battle with another one of these episodes. I feel I have been mis-diagnosed my whole life and that I now have a much more severe sinus issue. Can you provide an alternate diagnosis or suggestion for where I might turn next?

Thank You,

XXXX
Posted Fri, 22 Aug 2014 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Naveen Kumar 5 hours later
Brief Answer:
Please see the answer below...

Detailed Answer:
Hi Mr. XXXXXXX

Thanks for posting the query. I have gone through the description thoroughly and I have understood your problem. I'll do my best to help you out with this problem.

1. You seem to be having Vasomotor Rhinitis associated Sinusitis and Migraine. Each has to be dealt differently in order to get relief.

2. Sinusitis and Migraine usually coexist. When your nose is stuffy and the sinuses are blocked, you will have headache. And vice versa, when the headache (because of migraine) is present, the nose gets blocked.
3. Allergy doesn't have a cure. No amount of medicines in the world can cure allergy. Prevention is the best treatment.
4. Similarly, Migraine too doesn't have a cure. Prevention is the best treatment.
5. First of all, you need to get a CT scan of the Paranasal Sinuses, to look for any sinus related issues. Depending upon that, further treatment can be planned.
6. Drink plenty of warm water and do steam inhalation regularly - both of the above measures are to relieve the nasal congestion, clear the nasal secretions and to open up the sinuses.
7. Sleep adequately, everyday try to have food at the same time, exercise regularly; avoid going into sun as much as possible and avoid loud music and bright lights.
8. Avoid coffee, smoking, alcohol, chilled food/beverages, cheese, chocolates canned food.
9. You need to use saline and steroid nasal spray, along with an oral antihistamine to relieve the nasal congestion and allergy. Try taking ibuprofen or diclofenac instead of plain acetaminophen and amytriptalin. Also, you will require a multivitamin containing magnesium to treat migraine.

Hope I have answered your query. Please revert back to me with CT scan report. I'll try to help you in the best possible way.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
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