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What Causes Severe Facial And Frontal Headaches Along With Sinus Congestion?
Question: I have had severe facial and frontal headache with sinus congestion - ears ache and pop, all my top teeth hurt. Minimal nasal congestion, no fever, no sore throat, mild cough with sinus drainage- pseudafed doesn’t help- Vicodin does not relieve pain. Having trouble with balance and have fallen down several and started to fall and caught myself numerous times. Sinus ct neg, I course abx - no help- this has been going on since Nov 2017. What’s wrong with me?
Brief Answer:
Needs neurologist review and nerve pain suppressants.
Detailed Answer:
Hi,
Based on the history you have shared, though the pain is very much typical of acute sinusitis however a negative CT doesn't explain so as usually, CT SCAN is very much sensitive to pick such sinus collections.
Other causes of such pains like trigeminal neuralgia, anxiety or cluster headaches or migraine should also be kept in mind however if CT couldn't pick the cause of the pain, a CT scan with contrast or MRI may also be done but before that detailed ENT specialist review is a must.
In some cases, resistant sinus infections need surgical drainage of the sinuses and done by an ENT specialist. Some fungal infections in this area may also be this aggressive so an early referral is a must.
Especially the issues with the balance etc can point to spread of infection towards ear cavities so it's better to be evaluated.
A neurologist opinion meanwhile can also be of help to exclude causes which involve nerve pains like trigeminal neuralgia or postherpetic neuralgia etc.
Meanwhile, more potent analgesics like tramadol or gabapentin can be used. If severe duloxetine or carbamazepine can also be used along with OTC analgesics like acetaminophen etc.
Hope I have answered your query.
Regards,
Dr. Saddiq Ulabidin, General & Family Physician
Needs neurologist review and nerve pain suppressants.
Detailed Answer:
Hi,
Based on the history you have shared, though the pain is very much typical of acute sinusitis however a negative CT doesn't explain so as usually, CT SCAN is very much sensitive to pick such sinus collections.
Other causes of such pains like trigeminal neuralgia, anxiety or cluster headaches or migraine should also be kept in mind however if CT couldn't pick the cause of the pain, a CT scan with contrast or MRI may also be done but before that detailed ENT specialist review is a must.
In some cases, resistant sinus infections need surgical drainage of the sinuses and done by an ENT specialist. Some fungal infections in this area may also be this aggressive so an early referral is a must.
Especially the issues with the balance etc can point to spread of infection towards ear cavities so it's better to be evaluated.
A neurologist opinion meanwhile can also be of help to exclude causes which involve nerve pains like trigeminal neuralgia or postherpetic neuralgia etc.
Meanwhile, more potent analgesics like tramadol or gabapentin can be used. If severe duloxetine or carbamazepine can also be used along with OTC analgesics like acetaminophen etc.
Hope I have answered your query.
Regards,
Dr. Saddiq Ulabidin, General & Family Physician
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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