Surgical intervention?

I'm having chronic & perpetual Frontal band-like "Tension headaches." Not a day of relief in years. Feels like I have vise-like pressure & tighness in my forehead & eyebrows. I also have sinus pressure & perpetual congestion & sniffeling. Sinus symptoms are exacerbated why lying down or sleeping.

A Year ago, I had a CT that showed mild thickening of my ethmoid & maxillary sinus. ENT did an anesthetic block of my septum/turbinates to see if it relieved the head symptoms. It didn't help & thus he was loath to do sinus surgery. He gave me an antifungal nasal rinse but it didn't help either.

I had a recent MRI (a year after seeing my ENT). It says: There is mucosal thickening of the ethmoid air cells as well as the maxillary sinuses bilaterally. A small air fluid level is present within the right maxilary sinues. Globes are symetric. There is mild tonsillar hypertrophy.

1. Could this be causing my Head symptoms?

2. Should I return to my ENT at an Academic hospital for re-evaluation?

Thanks for your input & I truly Appreciate all that you do for us.  

[Vivek V Gurudutt, MD]

In general, it is not recommended to pursue surgical intervention for headaches if there is not compelling evidence on imaging or physical exam to provide a correlation.  Your history of tension headaches makes evaluation of sinus pain more complicated and your ent is proceeding with caution.  Many physicians would agree with that approach.  Sometimes, definitively correlating your symptoms with a specific disease process is very difficult.  I would definitely follow up with your ent and review your symptoms with your imaging and exam.  If the symptoms continue and surgery does not seem indicated, consider an evaluation by a neurologist for the headaches.  Good luck.