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Chronic Headache Pain- Could sinusitis be a trigger?

  I am 24 yr. old female that has suffered with sinus headaches since childhood.
  Sinus headaches were especially frequent during adolescence.  About four and
  a half years ago I began to have migraine headaches (the classic- aura,
  vomiting, throbbing,etc...) They are in my family(mom, great aunt, and
  grandmother on dad's side). At first I was living on narcotics but eventually
  was able to somewhat manage the headaches with Imitrex and prescription pain
  medications. I have had many trips to ER over the years. I still was having
  migraine headaches 2-3 times a week, this slightly decreased upon graduation
  from college. I have noticed a relation to my headaches with low blood sugar.
  So, I was able to manage the headaches somewhat by avoiding sugar and
  eating small meals with protein.
   Over the years I have tried anti-depressants,anti-inflammatories,beta-blockers
  etc. to prevent the headaches but nothing seemed to work. I had allergy testing
  4 years ago due to sinusitis and the migraines starting but stubbornly did
  not begin allergy shots. This last year I was diagnosed with a sinus infection
  8-10 times and eventually was put on Augmentin 875 mg,and treatment with
  Prednisone. I had a CT scan of my sinuses in June '98 that was clear.
  However, I still experienced daily pain(more than previously), drainage
  -many times yellow, stuffiness, headache that felt sinus-related that
  would eventually turn into a migraine, fatigue...  It seemed that Imitrex was
  no longer working and I began to live on pain pills. (Not easy as a
  1st grade teacher!) Largely due to the daily pain and fatigue I made the
  decision to not work full-time as a teacher this fall but to go to graduate
  school part-time and try to get well!
   I eventually saw a ENT specialist in September '98(My PP did not think my
  migraines were sinus related)the ENT recommended endioscopic surgery because
  of the recurring sinusitis. He was upfront that the surgery may or may not
  help reduce the migraines. He also recommended I visit a neurologist. I had
  successful surgery Oct. 14, 1998. The Dr. found my anatomy to be very unusual,
  something he had never seen before and also could not find in research. My
  middle turbinado bones in my nose had unusually formed "extra" parts that
  blocked off drainage in my nose.  Also, the anatomy in my sinuses is very
  unusual(according to the Dr.) with a ridge under my eye that makes it
  difficult for him to see much of my sinuses. He did remove the diseased
  tissue so I thought I would experience great results.
   Since the surgery I have not seen much if any positive results, only
  better ability to inhale more air in my nose. I am still having chronic
  headaches and Imitrex does not work like it once did unless I am having
  a "typical" migraine.  Most days I wake up with what feels like sinus pressure-
  pain behind and below my eyes that eventually moves up by head and then back
  and eventually a migraine. This is when only pain meds. bring relief (Sometimes
  they don't either) Also, I am stuffy and try to blow my nose, my nose
  is constantly itching.  My ENT does believe my allergic reactions could
  trigger migraines (I will be starting shots soon) but says that I'm not
  have sinusitus related migraines. My ENT did an endioscopic check up in my
  sinuses 2-3 weeks ago and said they looked swollen. He ordered another
  CT scan done so he can see what is going on.  Results have not come back
   I have been "living" on Augmentin since July.  I do feel better when I am
  on Augmentin. The Dr. will take me off of it and the pain comes back.  So
  then I go back on it.  My PP says it is helping with inflammation, probably
  not infection. So, I had a steriod shot about 11 days ago to help with
  inflammation. It seemed to help for about a week, my headaches decreased
  in frequency. Now they are bad again.
   I visited a neurologist last week.  He has started me on Inderol and said
  it is highly effective in preventing the frequency and severity of migraines.
  He did not address the allergy/sinus issue. I do not know if his speciality
  is headaches, I went to the neurologist my PP recommended.  Please respond
  with your opinion. I have been unable to work full-time this year and I am so
  very frustrated with the daily pain.  I do not understand why I have this
  pain everyday and it seems so uncontrollable.  Do you think it could be sinus
  related? Have my migraines just changed? Any help you can provide would be
  much appreciated.  Thank you.  
I think that you are in the unfortunate position of having two distinct problems each of which is causing headaches independently, but in some cases the sinus headache possibly due to the associated stress is sparking off a separate migraine headache.
As always when there are two problems it is best to attack one separately and rationally first rather than trying several things at once.
For this reason I would think that your neurologist ids taking the correct approach.
Your headaches are of such frquency that you do need constant preventative therapy, and Inderal is a good place to start, if this does not work a drug called Depakote, which is widely used as an anti-epilepsy medication is also effective. I think that you should give these options a chance.
The sinus headaches would appear to have a number of causes, your unusual anatomy, chronic infections and allergies.  The best approach for this would be to get started on the allergy shots as soon as possible and run these in parallel with the medications to prevent your migraines.


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