BRENT - Question about sinuses

Hi Brent. I am beginning to wonder if sinus issues could possibly be causing my son Paul's daily migraines - or headaches or whatever they are. Your post got me thinking when you said you had been told they were migraines, but hadn't really had typical migraine symptoms, etc. This is kind of how Paul is too. His migraines start out at full throttle - they don't build. Also, he's been waking up with them lately and happens to have a cold or allergies going on now.

Plus, he has had a CT scan done and one of his sinuses is closed off and he has some other abnormalities (somewhat of a deviated septum for one) , but the ENT didn't seem to know/think if they could cause his headaches. He didn't act like anything was in dire need of fixing, but who knows. (So of course that makes me think we should see a different ENT).

Did your sinus surgery to open up your sinuses help your headaches? Was the surgery difficult and painful? I am so torn as to whether I should pursue this avenue - we've done so many avenues that have lead to nowhere and I don't want to put him through something horrible if it's not the answer. Partly it's hard because my husband and I are the ones who are "directing" things since he is only 16. If he had his way, he would not want to pursue it (I think he's just plain tired of trying things and having them not work.)

I just wondered how your head has been since you fixed your sinuses. Thanks for any info. Alexis

I'm not Brent, but I've had the septoplasty (correction of a deviated septum) and also had 'windows' enlarged to let things drain better. For me it's been helpful, but not the correction of all my migraines. This winter I'd fought a sinus infection, and it took four rounds of increasing dosages of steroids to get the inflammation down to where it no longer triggered daily migraines.

I do think that swelling and inflammation play a part in my migraines, but idk if they're part of everyone's. Prior to going the surgical route, a decent ENT is probably going to want to try a couple of rounds of steroids/antibiotics, but if your son's issues do need surgical correction, this would get him on the path.

Hope my info helped.

Sara, I agree with you. There is too much made of sinus as a cause of chronic Migraines. The two issues are often very confused - just becasue they are in the same region.

Sinus problems are not chronic (unless very, very badly neglected) but are caused by an infection - sinus need to be treated by antibiotics.

IN the same region there is a complex network of nerve channels in this region above your nose etc which gets very badly inflamed during Migraine, and this often gest confused with sinus problems - but it has nothing to do with sinus.
This is when a treatemnt with steroids works, since steroids act as anti -inflammatory.

This is also a reason why sinus operations are waste of time (and money) as a Migraine treatemnt, since pain in that region is in not always related to sinus.
If you had been given steroids before your operation, you would most likely get the same reasult without going through the pain, of an unnecessary operation.
I have, in the past, used short course of steroids to break a bad cyckle of migraines. It works since there is inflammation present during Migraine.

Alexis, I understand your concerns, but Sara's advice is very sound.

I would only add that before you take a surgery route, perhaps more aggresive anti-allergy treatment with a right specialist doctor might bring improvement for your Son.
I am sure you have already tried many things, but there are new developements all the time, like de-sensitising injection which works well in so many cases, and similar. Also finding as many allergy triggers as possible and eliminating them is also important. I know that it is hard to see your loved ones suffer, and it is a slow road to improvemnt, but do not loose hope.

Sometimes it is a question of baby steps, sometimes it might be surgery - but he is still young and you will find a way,
with best wishes
Senna

Too many people here have been persuaded to have such unnecessary operations before other options were tried and tested.

I did need the surgery, as I had done multiple courses of antibiotics and steroids without reducing the infection or inflammation, but I see what you're saying Senna. For me, when I had the surgery (back in 1998), it was the treatment I needed, but this winter, when things got bad, a strong course of steroids helped without having to go a surgical route.

If his CT actually showed a structural/congenital blockage then that does need to be corrected. Mine was completely blocked but it didn't appear that way on the MRI's and CT's.

It's simple physics. If you have an encapsulated chamber (sinus cavity) and the air pressure drops the chamber will expand. Our Trigeminal and Maxillary nerves are right under and next to the main sinus cavities. Nerves do not require very much pressure before they start firing off intense pain signals.

My sinus surgery has eliminated 90% of my head and face pain and I am still in the healing window since the surgery. The surgery is not very comfortable but within two weeks I was mostly over the hump pain wise.

I am also sleeping so much better now that my right sinus has been expanded. For me the surgery was a win-win proposition. At the very least I will have a bigger opening to breath through and quite possibly elimination or decrease in the head and face pain.

A lot of sinus problems can be managed with eliminating dry forced air heating, avoiding allergens and keeping them irrigated and moist.

My wife has deformed sinuses but as long as she keeps them moist and flushed with nasal irrigation she rarely has a problem.

But if one of the chambers is closed off, even just part of the time, then you will have problems.

For me the surgery was uncomfortable and down right painful but even just a few weeks out I am so very glad I did it. I might need another one on my frontal sinuses since they also like to close off despite all I do to manage it.

Thanks for all your replies everyone! We will have to see what our next step is - I may have to talk to a new ENT and see what they think - we are just getting burned out talking to doctors all the time. I appreciate everyone's answers!

i am glad this post is on here...i have been going through the same thing..with my right sinus constantly closeing espeacially at night causeing pain then triggering headache/migraine...i have been to an allergist who strongly suspects allergies since this tends to happen feb-may and i get relief useing afrin nasal spray but only in the right sinus...next stop will be ENT dr. i also went to pain management clinic whose beliefe is treating mind,body and spirit so have hopes there as well...i do have degenerative disc disease in my neck to the point i need surgery but am trying to avoid it...but may be a candidate for injections or nerve ablation...so we will see....so many things that can be triggers...

magic

Surgical scar tissue won't inflame like regular mucosa tissue will when irritated by allergens. That went into part of my decision to go for it. Recovering from sinus surgery is much easier then dealing with all the allergens we have to exist with. Long term use of decongestant and steroidal nose sprays will cause damage and make things much worse.

See if you can find an ENT doc that specializes in barotrauma. Any military hospital or clinic could refer you to one. They have pilots and divers that get sinus and inner ear injuries that need to be treated. You could even call my doc to see if they have a referral they can give you closer to home.

Dr Charles Souliere at the Tacoma Ear and Balance Clinic (253) 426-6731

I know about the doc run around but I am glad I stuck with it and trusted my gut and own research. After two hellish years of pain, med side effects, lost work, lost play and three neuros I finally got relief. The first ENT doc completely missed the blockage.

Let me know if you have any other concerns or questions. My situation may not be exactly the same as your son's but it sounds very close. If I can save him the suffering I had then I am here and will do whatever I can.

Edited to add: There is a big difference in congenital/structural blockage vs inflammatory which comes and goes. Mine was structural and no amount sprays or decongestants can change that. There has to be some carving and drilling.

I know after reading Brent's posts on sinus issues, I got to thinking about it. Mine are so triggered by the weather and when I had an MRI back in October - there was something in my sinuses. After 4 months of things being horrible and not responding to meds, I made an appointment with an ENT. Had a CAT scan just prior to the appointment so we could look at it together and see if there was something obvious.

My scan showed a tiny blockage in a small passage and a bit of thickening in one of my facial sinuses. Not enough to be causing my problems and nothing requiring surgery. It also was on the eve of a pressure front coming through so in theory things should have been at their worst (sure feels like it today). She did give me a nasal steroid to try - just samples. She wasn't optimistic it would help but if it tones down the low pressure front stuff, it would be worth it. If it does nothing (which is more likely), well it's one more thing I've tried.

I am glad I did have this checked - just know that it's most likely one factor that's not contributing to the migraines. And it's not one of those things "have you _____".

ajr - I guess my thought is to get a second opinion. If there is something there, it won't hurt to have a second pair of eyes look at it. I know it's a giant pain but if it saves your son years of pain and suffering...

Best wishes.

Keep in mind my CT's and MRI's did not show a blockage. So if one does show up then you can be sure it's more serious.

My ENT doc said that the tissue around the sinus cavity opening is not dense enough to shadow X-rays or give out an MRI signal. So what appears to be slightly open may not be. The average radiologist is not going to be as thorough as an ENT doc that deals with that on a daily basis.

If you are affected by a falling barometer, flying or going over a mountain pass then you have an encapsulation that is expanding instead of venting/equalizing like our inner ears do.

We have two bursa sacks/pillows in our shoulders that are a cushion for a tendon so it does not rub on bone. They are also an encapsulation. As we age they don't vent as good and inflame. AKA bursitis.

People blame it on the dampness/rain since clouds come in when the pressure drops. Some even move to a drier climate. They never take into account that if that was the case they would have a flare up every time they showered, bathed or swam.

The bad news is even drier climates have barometer drops just it doesn't mean rain will happen as much. So they do not any other relief then thinking they have less pain.

Absolutely Brent. I do seem to fit the category, as I hate flying - it does something to my head (lots of ear pressure but with my current status, pure torture) and I do feel the effects at elevation changes. But I also don't have some of the other issues - no allergies, no congestion...none of the stuff that makes you miserable.

The ENT and I reviewed the CAT scan and I'm not concerned. However if the inhaled steroids make a difference (like a major one), I may review it again. I think then there may be more to it than what was seen. The MRI showed a cyst - that was what got me thinking but nothing more.

I was always told my scans were clear. But years later an ENT looked at new and old scans and said alot of blockage was missed. So I did the surgury and my every day 7-8 pain went to every day 5-6 pain. I really did help. Still get the migraines but it helps me deal with them better when I can breath good.

Brent wrote:If you are affected by a falling barometer, flying or going over a mountain pass then you have an encapsulation that is expanding instead of venting/equalizing like our inner ears do.

We have two bursa sacks/pillows in our shoulders that are a cushion for a tendon so it does not rub on bone. They are also an encapsulation. As we age they don't vent as good and inflame. AKA bursitis.

People blame it on the dampness/rain since clouds come in when the pressure drops. Some even move to a drier climate. They never take into account that if that was the case they would have a flare up every time they showered, bathed or swam.

The bad news is even drier climates have barometer drops just it doesn't mean rain will happen as much. So they do not any other relief then thinking they have less pain.

Interesting explanation, Brent. Could the encapsulation in the shoulders also be the cause of upper back, neck & shoulder pain when flying? I get both the migraine and the neck/shoulder/upper back pain with pressure changes and any traveling.

Thanks!

Becky

Brent,

I have been to ENTs over and over again trying to find an explanation to this HORRID pain I get from flying. Nobody seems to be able to provide any answers. I cannot pop my ears, it builds in pressure and causes stabbing shooting pains that are intense throughout the ascent and descent. It also happens in elevators, driving in cars, rolling down windows, bad weather changes, ect. When I do fly, after hitting the ground I cannot hear right for days after the flight unless I tip my head upside down. As soon as I go right side up again I hear in muffles again. Does this sound like the blockage you are speaking of? If so..bless you for figuring out what so many people could not. I have been avoiding flights because a few ENTs told me the pressure could damage my ear drums permanently.

My inner ear always equalizes OK when I go over any of the mountain passes or I go up to Mt Rainier (6000'). But I did quite often get ringing and a low freq buzzing as the pain kicked in. The ENT doc said it was nerve excitation from the severe sinus pain signals. All of our facial nerves have a very short distance to the ganglion and then to the spinal cord. You get an interference or spill over effect.

Have you tried a big dose of nasal spray and oral decongestants before flying? The spray gets into the entrance of the Eustachian tubes (inner ear) and will shrink the tissue if it's inflamed. But you could have congenital small openings and the slightest inflammation will close them off.

You just have to keep looking for a decent ENT doc that will take the time to figure out what is happening. It can be exhausting and frustrating when you are hurting and know there is relief.

My mother in law worked several years with my ENT doc and she said he likes a challenge and will keep chipping away at a problem until fixed. That seems to be a rare practice with a lot of docs these days. Certainly neuros in my case

The twisted irony in my case was my ENT doc all along was only one mile from where I work.

I guess my mission now is to let others know that your migraines just may not be true migraines and there is a treatment. Considering 35% of mig patients are air pressure sensitive I hope everyone that might be suspicious gets it checked. However the first, second or even third ENT doc may not be any help.

I consider myself semi lucky to have found mine but half of the mission was self educating and raw persistence.

On the flip side a lot of people diagnosed and treated for sinusitis may actually have migs. So that is why I feel it's important to make sure you have the right diagnosis and treatment. A lot of docs are screwing it up.

Brent, Thanks for your very fast reply. I have tried TONS of nasal decongestants and oral decongestants, even prescription medication that ENTs gave me to use on the plane. I have tried numerous ear plugs as well, a few different homeopathic treatments and all the chew gum, swallow, drink water, put a cup of hot water up to your ear..ect ect. I hope one day I find out what it is that is effecting my ears, maybe it is connected to the migraines. Right now I just don't have the money to search doctor to doctor because I am already going to neuros and specialists and getting testing which is running up the bill month to month. I am happy you were able to find your problem though! Very happy! Thank you for sharing your experiences with us because I am more aware that my ears and migraines might be connected.

That has to be frustrating and I hope you find some relief. Don't stop looking and reading. I was able to dip into my stubborn Irish genes and put them to good use.

Right now we have another storm coming in and and I still have some minor pressure. But two months ago I would have been down for the count in pitch black room trying to not puke. So I am not cured but I'll take a 90% reduction in pain over nothing.