Hello, I am 21 year old male and as far as i know i am in decent health. The last month my over all health has declined quite a bit. I have been having daily headaches with occasional nausea dizziness and i am usually quite fatigued all day.Sometimes it is so bad i feel weak and almost faint.The pressure seems to almost get stronger when i walk and have to do phisical activity. The headaches are lower head and neck pressure that starts mid day and usually last in tell the day is done. I am uninsured and recently bit the bullet and paid out of pocket to see a general practitioner. A over all phisical was performed blood pressure was normal. Throids felt normal. But upon inspected my nasel cavity the doctor sed my sinuses seemed inflammed and i had post nasel drip. She diagnosed it as Sinusitis with no evidence of bacterial infection. And prescribed me Albuterol for my asthma, an antihestimine for my allergies and nasonex for my sinuses and sed that that the combination should clear up my sinus problems and hopefully alleviate my headaches. But as a precautionary step She ran blood test for HIV/AIDS HEP A/B/C a liver panal kidney panal and a thyroid panal and white blood cell count she also checked my blood suger. All test apparently came back normal.
It has been almost a month with this treatment and my symptoms have not improved. The headaches are still there and are getting worse with phisical activity the fatigue feels so bad sometimes it takes effort for me to walk even a few blocks and then i feel extremly lightheaded and faint.
The only thing my doctor could recommend is that i should get an MRI and CT scan. Which uninsured will be hard to pay for.
1. Sinus headaches usually worsen during the day as the maxillary sinuses fill up during the day. This is because the openings of the maxillary sinuses are high up in the nose. On lying down the maxillary sinuses drain as a post nasal drip and the headache subsides. Most headaches worsen on walking, physical activity and exertion.
2. The sinuses have a vast surface area and hence with the slightest infection and inflammation the toxins are absorbed easily into the blood stream and cause the nausea, dizziness, weakness and fatigue. The post nasal drip can also causes acidity and reflux.
3. Assuming that your underlying condition is allergy, do you have sneezing and watery discharge (rhinorrhea) and nasal obstruction? Do you also have aspirin sensitivity? Asthma and sinusitis are related and treating the sinusitis relieves the asthma to some extent.
4. In order to relieve your symptoms, you should discuss the following with you GP : 1. starting a newer generation anti-histamine (such as levocetrizine or rupatadine) and an anti-leukotriene (such as montelukast) once a day. 2. Instead of Nasonex, switch to budesonide, fluticasone or ciclesonide nasal spray. Get your physician to prescribe these for at least two weeks and check the response. Also Start regular steam inhalation through the nose and mouth for 10 minutes at a time. If you do not respond, the headache does not reduce or if steam inhalation makes you feel worse then you probably have significant nasal obstruction or a DNS (deviated nasal septum) or hypertrophied turbinates.
5. It is difficult to see the sinuses on nasal examination as they are surrounded by bone and their openings are very small and usually hidden. The gold standard investigation is a plain CT PNS (Para Nasal Sinuses) on a multi slice machine. This can wait as usually at your age there should be nothing major.
6. Besides sinus headache, tension headache and migraine should be ruled out. Ideally an MRI or MRA is done for headache that does not respond to medication. If the headache subsides on its own or on taking medicines, MRI is usually not necessary.
Hope that this information helps and hope that you will get better soon.
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