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Neurology (Expert Forum)
Pressure Headache - I think I know what's wrong now, but....
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Pressure Headache - I think I know what's wrong now, but....
by Citizen T, Mar 23, 2006 12:00AM
Hi Doc, I posted a long time ago about my constant dull pressure headache, frequent classic migraines (a very different, throbbing pain upon awakening) muscle tension in forehead, and a constantly blocked nose.
Well, I think I've found a possible answer but I'm not so sure. Normally my turbinates are both completely swolen and you can't see past the first set. I use phenylepherine, and instantly my nose opens up, the inferior turbinates completely shrink, and I can see the middle set which appear to be swolen but I'm not sure if they are in contant with anything. But what do you know about "middle turbinate headache syndrome" and do you think there's a reasonable shot that a simple resection surgery would help my condition? I am so frustrated because I keep telling my doctors I'm very sick and they basically ignore everything I say.My doctors are at a major university. Why do you think they ignore what I say? Are they just too busy with more sick patients, do they just not care enough to investigate, or is my "turbinate headache" some hopeful false fantasy that I've dreamed up? I do have an appointment with a nasal specialist soon, but due to my experience with doctors so far, I do not have the least bit of hope of solving my problem. The thought has crossed my mind to sell my car to pay for a trip to Mayo.
Please tell me how to get my doctors to listen to me, and do you think I could be onto something, if so how can it be proven?
A (unknown case)
B (turbinate swelling)
C (headache)
A leads to B, and B causes C OR...
A directly causes B AND C
Well, I think I've found a possible answer but I'm not so sure. Normally my turbinates are both completely swolen and you can't see past the first set. I use phenylepherine, and instantly my nose opens up, the inferior turbinates completely shrink, and I can see the middle set which appear to be swolen but I'm not sure if they are in contant with anything. But what do you know about "middle turbinate headache syndrome" and do you think there's a reasonable shot that a simple resection surgery would help my condition? I am so frustrated because I keep telling my doctors I'm very sick and they basically ignore everything I say.My doctors are at a major university. Why do you think they ignore what I say? Are they just too busy with more sick patients, do they just not care enough to investigate, or is my "turbinate headache" some hopeful false fantasy that I've dreamed up? I do have an appointment with a nasal specialist soon, but due to my experience with doctors so far, I do not have the least bit of hope of solving my problem. The thought has crossed my mind to sell my car to pay for a trip to Mayo.
Please tell me how to get my doctors to listen to me, and do you think I could be onto something, if so how can it be proven?
A (unknown case)
B (turbinate swelling)
C (headache)
A leads to B, and B causes C OR...
A directly causes B AND C
Doctor's Answer
by CCF-Neuro-M.D.-PW, Mar 27, 2006 12:00AM
I don't think any specific disease 'causes' turbinate swelling, but I am not an ENT specialist and this is more their realm. There is an association is some studies of headache and turbinate swelling, and in some case there is reported relief of the headache wirh nasal surgery. There are no randomized controlled trials that prove scientiffically that this is true, so you just have to go on expert opinion and case reports of improvement - you may benefit you may not, I don't think you can predct, but if you are willing to accept the risks of surgery and nothing else works it may be worth a shot.
For example here is one report published in the well respected medical journal 'Headache'
Middle turbinate headache syndrome.
Anselmo-Lima WT, de Oliveira JA, Speciali JG, Bordini C, dos Santos AC, Rocha KV, Pereira ES.
Department of Ophthalmology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil.
The middle turbinate and nasal septum are innervated by the anterior ethmoidal nerve, a branch of the ophthalmic division of the trigeminal nerve. As reported in the classical work of Wolff (1948), stimulation of these regions causes pain in the medial canthus of the supraorbital region. Periorbital pain due to middle turbinate compression against the septum or the lateral wall of the nose may be due to congestion of the nasal mucosa or to pneumatization of the middle turbinate (concha bullosa). The diagnosis is made by exclusion and requires a high index of suspicion, anterior rhinoscopy, computerized tomography (CT), and confirmation by the lidocaine test. We present five cases of middle turbinate headache syndrome, all with concha bullosa. Four were treated surgically by partial middle turbinectomy and septoplasty more than 1 year ago, with excellent results. One patient refused surgical treatment which was suggested after failure of medical treatment with antihistamines, decongestants, and a topical corticosteroid, and continues to be symptomatic. Despite the small number of cases studied, the authors concluded that the procedure used was effective for the resolution of headache.
For example here is one report published in the well respected medical journal 'Headache'
Middle turbinate headache syndrome.
Anselmo-Lima WT, de Oliveira JA, Speciali JG, Bordini C, dos Santos AC, Rocha KV, Pereira ES.
Department of Ophthalmology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil.
The middle turbinate and nasal septum are innervated by the anterior ethmoidal nerve, a branch of the ophthalmic division of the trigeminal nerve. As reported in the classical work of Wolff (1948), stimulation of these regions causes pain in the medial canthus of the supraorbital region. Periorbital pain due to middle turbinate compression against the septum or the lateral wall of the nose may be due to congestion of the nasal mucosa or to pneumatization of the middle turbinate (concha bullosa). The diagnosis is made by exclusion and requires a high index of suspicion, anterior rhinoscopy, computerized tomography (CT), and confirmation by the lidocaine test. We present five cases of middle turbinate headache syndrome, all with concha bullosa. Four were treated surgically by partial middle turbinectomy and septoplasty more than 1 year ago, with excellent results. One patient refused surgical treatment which was suggested after failure of medical treatment with antihistamines, decongestants, and a topical corticosteroid, and continues to be symptomatic. Despite the small number of cases studied, the authors concluded that the procedure used was effective for the resolution of headache.
I have registered negative on every single test given to me, but I have the same symptons you described. No doctor ever mentioned turbinate headache to me before last week, even though I have been describing these exact symptons in hundreds of doctor visits. I was very close to doing what you said about the Mayo clinic scenario. The results of the allergy tests I took came up 100% negative last week. Prior to that, I even paid for my own MRI brain tumor just to rule out anything else completely.
I believe this diagnosis above any of the other 100's of different diagnosis I have received in the past, but I will remain skeptical until the problem is resolved. I am opting for Somnoplasty for Chronic Nasal Obstruction if my symptons worsen or remain the same. I have had Somnoplasty for snoring before and the discomfort is short and it is an outpatient procedure. It takes a number of visits, but the visits are short like a regular doctor's visit. Best of luck to you in finding out the answer to treating your headaches.