Rhinitis...really?

Age 50, WM, 6'0, 220#

Ongoing for years., from my neck up is often hot. This produces headaches similar to a  migraine (never been diagnosed). I have with a long history of depression .  Nortriptyline for depression has helped with these headaches at first , but doesn't anymore.
These headaches produce vertigo, upset stomach, and the worst increased depression/ panic attacks. RAST tests for allergies shows negative. A medrol dosepac is the only thing that will take the swelling/ headaches away. There is no drainage . Some have called it Dry VasoMotor Rhinitis, but have offered no solution.

[bsmsl]

Some thoughts:
1) Blood RAST are notorious for false negatives.  See an allergist that does skin pr ick testing.  They are much more accurate.

2) Have you tried any of the nasal steroids?  They are supposed to help with vasomoter rhinitis.  

3) You need to see and ENT who won't give up on you.  Check the governing ENT board's web site for their physician referal page.  Then look for one in your area that has a fellowship in the board.  "Fellows" are much better doctors than "members" in my experience for more complicated patients.  They care more and will be more agressive in finding a treatment plan that works.

I hope that gives you some ideas.

[Dr Rajput]

Hi, welcome to the forum, you need a detailed evaluation. Flushing is sense of warmth and erythema on skin as you are having neck up. Possibilities of flushing with increased heart rate are Carcinoid syndrome (presents with diarrhea, tremors etc.), Mastocytosis, Pheochromocytoma, hyperthyroidism and pancreatic tumor/VIPoma. This is not due to allergy.

The tests like blood pressure monitoring, 24 hrs urine analysis for 5-HIAA, histamine, prostaglandin and catecholamine and other blood tests will help for evaluation of the cause.

Headache can be due to Migraine. In this type of headache one will have throbbing headache. Migraines can be triggered by stress, worry, physical exertion, fatigue, lack of sleep, hunger. There would be presence of certain triggering factor, smell of certain things in your case. There also be a psychological dislike towards certain things like taste of a food, smell etc. which can further trigger the event.

You need to complete sleep and mental relaxation. Identify any triggering factor as mentioned above including any specific food which can cause this and stay away from these. OTC pain killers will help to relieve the pain and also takes care of triggering factors in the brain. You may need imaging studies like MRI or CT of Brain, if headache is persistent. Consult neurologist. Take care and regards.

I suggest you to consult physician. Take care and regards.