[38F] With chronic headaches and dizziness

Patient Description

A 38-year-old female has been experiencing constant headaches with sinus pressure, pain in the temples, behind the eyes, and eye pain for the past 11 months. The headaches are mostly constant but can be throbbing at times, with a severity rating of 6 out of 10. The patient reports facial puffiness, light sensitivity, occasional sore throat, inflamed sinuses, and difficulty sleeping. Additionally, she experiences moderate dizziness with a spinning sensation and occasional loss of balance upon standing, also ongoing for 11 months. Medical history includes fibromyalgia (diagnosed in 2017), tachycardia (diagnosed in 2018), and a blood clotting disorder (diagnosed in 2010). The patient has no known drug allergies and is currently taking Tylenol once a night, although the dosage is unknown.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Chronic Sinusitis: This condition involves inflammation of the sinuses that lasts for at least 12 weeks. Symptoms include facial pain or pressure, nasal congestion, and headaches. Chronic sinusitis can also cause dizziness and a feeling of fullness in the face.

    • Treatment: Treatment may include nasal corticosteroids, saline nasal irrigation, and in some cases, antibiotics if a bacterial infection is suspected. A doctor may also recommend imaging studies like a CT scan to evaluate your sinuses.
  • Migraine with Aura: Migraines can cause severe headaches, often accompanied by sensitivity to light, dizziness, and visual disturbances. The throbbing nature of your headache and light sensitivity are consistent with migraines.

    • Treatment: Treatment options include over-the-counter pain relievers, prescription medications to prevent or reduce the frequency of migraines, and lifestyle changes to avoid triggers.
  • Fibromyalgia: Given your history of fibromyalgia, it is possible that your headaches and dizziness are related to this condition. Fibromyalgia can cause widespread pain, including headaches, and can also affect sleep and cause dizziness.

    • Treatment: Management of fibromyalgia often involves a combination of medications, physical therapy, and lifestyle changes. Pain relievers, antidepressants, and anti-seizure drugs are commonly used.
  • Vestibular Disorders: Conditions affecting the inner ear, such as vestibular neuritis or benign paroxysmal positional vertigo (BPPV), can cause dizziness and balance issues. These conditions can sometimes be related to sinus problems.

    • Treatment: Treatment may include vestibular rehabilitation exercises, medications to reduce dizziness, and in some cases, procedures to reposition inner ear crystals.

What you can do

While you should consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Stay Hydrated: Drink plenty of water to help thin mucus and reduce sinus pressure.
  2. Use a Humidifier: Adding moisture to the air can help relieve sinus congestion and pressure.
  3. Over-the-Counter Medications: Continue using Tylenol for pain relief, but consider adding a decongestant or antihistamine to help with sinus congestion. Always follow the dosage instructions and consult a pharmacist if you have questions.
  4. Rest and Relaxation: Ensure you get adequate rest and try relaxation techniques such as deep breathing exercises or meditation to help manage stress and pain.
  5. Avoid Triggers: Identify and avoid any known triggers for your headaches, such as certain foods, strong smells, or bright lights.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe Headache: If your headache becomes severe or is different from your usual headaches.
  • Neurological Symptoms: If you experience new or worsening neurological symptoms such as vision changes, difficulty speaking, or weakness on one side of your body.
  • Persistent Dizziness: If your dizziness worsens or you have difficulty maintaining your balance.
  • Fever: If you develop a fever, which could indicate an infection.

Remember, this information is not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and appropriate treatment.

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6 mo ago


People Also Ask


What are the common symptoms of chronic sinusitis?

Common symptoms of chronic sinusitis include facial pain or pressure, nasal congestion, headaches, dizziness, and a feeling of fullness in the face. It can also cause a reduced sense of smell and taste.


How can migraines with aura be managed or treated?

Migraines with aura can be managed with over-the-counter pain relievers, prescription medications to prevent or reduce the frequency of migraines, and lifestyle changes to avoid known triggers. It's important to consult a healthcare provider for a tailored treatment plan.


What are some effective treatments for fibromyalgia-related headaches?

Fibromyalgia-related headaches can be treated with a combination of medications such as pain relievers, antidepressants, and anti-seizure drugs. Physical therapy and lifestyle changes, including stress management and regular exercise, can also be beneficial.


What are vestibular disorders and how are they treated?

Vestibular disorders affect the inner ear and can cause dizziness and balance issues. Treatment may include vestibular rehabilitation exercises, medications to reduce dizziness, and procedures to reposition inner ear crystals if necessary. Consulting a healthcare provider is important for an accurate diagnosis and treatment plan.

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