On April 17th, 2003 I began getting headaches.  They were pretty mild
at first, so I pretty much ignored them.
The symptoms were a constant mild background headache in my forehead,
but a severe shooting pain in that same area upon exertion, brought
about by sneezing coughing, or any sudden strenuous movement.  The
shooting pain also appeared when I bent over, indicating that perhaps
it was caused by pressure.

On May 15th (about a month after the headaches started) I went to see
a neurologist.

I had a MRI done, and the brain looked normal, but it appeared I had a
sinus infection.

On June 3rd I saw an otolaryngologist, who order a CT scan, which
showed a pretty bad sinus infection.
On July 8th, I got a second opinion from another otolarygologist, who
confirmed the sinus infection, but also noted that my frontal sinuses
were pretty deformed.  After a course of steriods and antibiotics, I
had another CT scan, and it looked like almost the entire infection
had cleared up, but the headache symptoms remained.

After seeing a 3rd otolaryngologist, I decided to wait and see if the
headaches would go away on their own.  The headaches continued, and
finally I decided to have surgery to clear out and obliterate the
frontal sinus cavities.  The surgery took place on November 4th, 2003,
about six months after the onset of the symptoms.

After the surgery, the headaches never went away completely, and now
(about five months after surgery) the headaches are nearly as bad as
they were before surgery, and getting a little worse every week,
suggesting to me that perhaps the sinus infection was a red herring.

The pain is to the point where I can no longer play tennis, as the act of
serving (for example) causes a terrible shooting pain in the forehead area.

It also is becoming difficult to reach down and pick up my kids.  I am 40
years old, and otherwise am in good shape and healthy.

My question is:  what is causing this headache, and how do I make it go away?

---

Request for Question Clarification by livioflores-ga on 12 Apr 2004 17:05 PDT

Hi!!

Unfortunatly we cannot diagnose your condition, we are not physicians
and we not have the back up of your brain studies.
What we can do is to tell you where you can go for and where you can
see valuable info that lead you to discover what causes your
headaches.

Try to start with:

"CATEGORIES OF HEADACHE" from the National Headache Foundation:
http://www.headaches.org/consumer/presskit/NHAW03/NHAWcategories.pdf

"National Headache Foundation: Educational Resources (professional)".
http://www.headaches.org/professional/educationindex.html

"National Headache Foundation: Educational Resources (patient)"
http://www.headaches.org/consumer/educationindex.html

"National Headache Foundation: Press Room"
http://www.headaches.org/consumer/pressindex.html
http://www.headaches.org/professional/pressindex.html


"Tension Headache Fact Sheet" from the University of Berkeley:
http://www.uhs.berkeley.edu/home/healthtopics/pdf/tension.pdf

"Arteriovenous Malformations (AVM)" (one possible cause):
http://www.mayfieldclinic.com/PE/PE-AVM.HTM

"constant headache - Sponsored constant headache website":
http://mirabye.com/teh/4/constant-headache.html


I hope that this links give you an approach to the correct diagnosis. 
If one of this links gives you some info that suits with your
condition, please tell us and we will research hard on that topic. We
are waiting for your feedback.

Regards.
livioflores-ga

---

Request for Question Clarification by umiat-ga on 12 Apr 2004 19:03 PDT

Hello, tpymeyer!

 You must be miserable, and quite discouraged! I have run across
several sources of information that discuss the recurrance of sinus
infections, even after a patient has had * several surgeries. *  There
are numerous possible causes for recurring infections and a number of
treatment options that can be considered.

 Since three doctors plus CT scans confirmed the presence of infection
and the MRI appeared normal, the infection route seems the most likely
course to pursue.

 While I am compiling some suggestions, it would help if you could
answer the following questions:

1. What antibiotics did you take and how were they administered? Were
they in pill or liquid form, or was the medication nebulized?

2. Have you ever been tested for persistent allergies in conjunction
with your sinus infection?

3. Did the doctor test for a fungal infection, either before or after the surgery?

I must reiterate that researchers cannot provide a diagnosis. It is
impossible to say definitively "what is causing this headache, and how
you can make it go away?

 However, it is very possible that you have a recurrant sinus
infection that has not responded to surgery or the particular
antibiotics you were prescribed. I can certainly provide information
concerning treatment methods for recurrant sinus infections after
surgery, and possible causes for the continual infection.

I will be working on an answer to your question while awaiting your clarification.

umiat

---

Clarification of Question by tpmeyer-ga on 12 Apr 2004 20:32 PDT

The antibiotic was a two week course of 1000 mg Augmentin 2x daily
taken in pill form. (maximum dosage I think).

The initial CT scan suggested that there indeed was a fungal
infection, but the CT scan taken after the two weeks looked clear.  I
was never specifically tested for a fungal infection, but it was
assumed that I had one, and the antibiotics cleared it up.

I have never been tested for allergies, but have been quite healthy
for the first 40 years of my life, and have had no known allergies.

Hello, tpmeyer!

The first point I want to make is that you are definitely not alone!
Recurrent sinus infections and headaches are not uncommon even after
numerous surgeries!

While it is certainly possible that your headaches are due to another
cause, it seems logical to start out with information relating to
persistent sinus headaches and treatments simply because your tests
did show signs of infection. Therefore, the first portion of my answer
addresses sinus headaches.

It is also prudent to read about other types of headaches to determine
whether they present symptoms similar to your own, especially since
you have some doubts about whether your headaches actually have a
sinus origin. The second part of my answer addresses other types of
headaches that present with the type of symptoms you have described.

You might want to look at the references to "Cough Headache" since you
have noted: "The symptoms were a constant mild background headache in
my forehead, but a severe shooting pain in that same area upon
exertion, brought about by sneezing coughing, or any sudden strenuous
movement. The shooting pain also appeared when I bent over, indicating
that perhaps it was caused by pressure."


SINUS HEADACHES
****************
  
Sinus headaches are an affliction that can be very hard to treat, even
with antibiotics and surgery. Oftentimes, it takes a several-pronged
approach from various medical specialists to effectively combat the
condition.

Medicine.net notes makes it clear that surgery has various risks, including:

* Failure to resolve the sinus infections or recurrence of sinus
problems and/or polyps
* Need for further and more aggressive surgery
* Failure to resolve associated "sinus or nasal" headaches. The exact
cause of headaches can be difficult to determine or have many
different causes.

http://www.medicinenet.com/Sinus_Surgery/article.htm


MEDICATION AND TREATMENT
========================

"There are two types of chronic sinusitis: bacterial chronic sinusitis
and non-infectious sinusitis. Both of these types of sinus infections
can prove very harmful if not treated properly. Depending on what type
of chronic sinusitis you have and the severity of the case, there are
four main sinus medications and/or treatments that are commonly
prescribed: oral antibiotics, nebulized antibiotics, intravenous
antibiotics, and sinus surgery options."

"A broad-spectrum oral antibiotic is most often prescribed to aid in
the treatment of chronic sinusitis. As indicated in the name, oral
antibiotics are taken orally, and are usually ingested every day for
2-3 weeks. If after some time the broad-spectrum oral antibiotics
don't appear to be helping their patients' bouts with chronic
sinusitis, doctors will often take a sample of the infection in order
to determine exactly what type of infection their patient has, and
then prescribe an antibiotic specifically designed to help with that
type of infection."

"Nebulized antibiotics differ from oral antibiotics in that they treat
the infection topically. Generally, this type of antibiotic is taken
through the nose (similar to nose spray), which allows the antibiotic
to get directly to the affected sinus. This type of antibiotic is also
taken from 2-3 weeks."

"In special cases, doctors suggest an intravenous antibiotic. This
type of antibiotic is injected directly into the blood stream. This
treatment generally lasts 4-6 weeks."

"And as a last resort, sinus surgery options are explored. Sinus
surgery is reserved only for extreme cases of chronic sinusitis. Most
of these types of surgeries are endoscopic, which means that the
doctor can perform the operation without making any facial incisions.
While this surgery doesn't last long (1-3 hours), a full recovery can
last up to several weeks."

From "Sinus Infection Treatments."
http://www.sinusauthority.com/Sinus-Infection-Treatments.html


 
===========================
WHEN SURGERY DOESN'T WORK
===========================

According to Dr. W. S. Tichenor, "It is unrealistic to expect that
surgery will cure sinusitis, as the same processes which occurred
prior to surgery will continue afterwards. Surgical treatment simply
allows the sinuses, which previously did not drain, to drain through
the ostia."

Dr. Tichenor has compiled a comprehensive list of potential causes of
continued sinus headaches after surgical intervention. Some excerpts
follow:


Reflux
------
"It is speculated that some patients may have worsening of sinusitis
due to food or stomach acid refluxing or repeating i.e. coming up from
the stomach into the esophagus and subsequently into the back of the
mouth. It is unclear whether it is possible for it to actually get
into the sinuses. It is diagnosed by putting a tube into the esophagus
to check the amount of acidity. Treatment is with acid blockers
(Zantac, Axid, Tagamet, Pepcid, Prilosec, Prevacid, Nexium, or
Aciphex.) It is thought that some patients can have silent reflux,
i.e. they don't have any symptoms."


Immunodeficiency
----------------
"Any patients with chronic sinusitis which is poorly responsive to
treatment should have an extensive immunological evaluation including
immunoglobulin levels, possible IgG subtypes, and antibody testing."  
(Refer to article for more...)


Inadequate Surgery
--------------------
"Some patients operated on by inexperienced Otolaryngologists may not
have adequate surgery performed. If the uncinate process is not
removed (see the x-ray page), recurrence of symptoms is common since
proper drainage may not occur. (This is called a retained uncinate.)
Sometimes a surgeon will make an opening into one of the ethmoid
sinuses instead of the maxillary sinus. This can cause continued
problems with drainage from the maxillary sinus. Some patients also
may not have adequate amounts of ethmoid air cells
removed.......Occasionally, instead of a single ostium into the
maxillary sinus, there can be two openings created which can cause
re-circulation of mucous, (in one ostium and out the other). This can
lead to continued symptoms and may necessitate further revision
surgery."  (Refer to article for more..)


Frontal Sinus Disease
----------------------
"Periodically, frontal sinus disease will persist after surgery is
done on other sinuses. Usually frontal sinusitis will resolve without
surgery, however occasionally persistent disease will require
operative intervention. Sometimes it is possible to just perform
revision surgery on the ethmoid sinuses and that will allow the
frontal sinuses to drain properly. That decision must be made by an
experienced ENT surgeon."  (Refer to article for more...)


Fungal disease
--------------
"Patients who have recurrent disease also must be evaluated for fungal
sinusitis. The discovery of eosinophilic fungal rhinosinusitis (EFRS)
by the Mayo clinic has changed sinusitis treatment radically. Briefly,
it is thought that most patients with chronic sinusitis have an
unusual reaction to the normal fungi which are in everyone's sinuses.
White blood cells called eosinophiles attempt to destroy the fungus
and in the course of doing so injure the lining of the sinuses, which
allows the bacteria to proliferate. Treatment should therefore be
directed at the fungus rather than the bacteria. Other types of fungal
sinus disease include allergic fungal, invasive fungal disease, and
fungus balls."

*** "Once surgery has been done, it is much easier to do cultures to
determine if an unusual bacteria or fungus is involved. It is possible
to direct the culture into the involved sinuses at the time of
endoscopy. It is often difficult for many laboratories to find fungi
since they are difficult to culture for and grow out. In addition, the
usual techniques for culturing fungi are often suboptimal, and must be
specially modified to allow proper fungal culture. In addition, we
send specimens to a special fungal lab which is better equipped to
determine if there are fungi present."


Intravenous Antibiotics
-----------------------
"Some patients who have not responded to surgery may need to get
outpatient treatment with intravenous antibiotics for 6-8 weeks to
clear up infection which persists after surgery."

Revision surgery
-----------------
"Some patients will develop new areas of sinusitis post-surgically
which may or may not be able to be visualized on endoscopy and
sometimes require repeat CT scans. In those cases, oral antibiotics
are more likely to be necessary and in some cases surgical revision
either done in office or with hospitalization may be necessary."
(Refer to article for more....)


Additional Medications
----------------------
(Refer to article)


Dental disease
--------------
"We have started seeing an increasing amount of dental disease causing
sinusitis. This can be as a result of the root of a molar becoming
infected, the remnant of a tooth which was previously partially
removed, or bony like material in the base of the sinus. This can be
very difficult to treat and often requires a skilled dentist as well
as a sinus specialist. Sometimes there can also be a communication
between the mouth and the sinuses as a result of previous dental
work."


**** 

"Post surgical management in patients who have not responded to
surgery can be extremely difficult for most doctors to perform, as
most physicians do not have extensive experience with this kind of
patient. As stated elsewhere, it is difficult for many physicians to
treat patients with chronic sinusitis, but this is doubly important in
patients post surgery, as you must find physicians with extensive
experience in such treatment in order to provide optimal care."

From "Persistent Sinusitis Despite Surgery," by W. S. Tichenor, M. D.
http://www.sinuses.com/postsurg.htm

==

Please read more about Fungal Disease:

"Fungal Sinusitis," by W. S. Tichenor, M. D.
http://www.sinuses.com/fungal.htm
 

==

Dr. Tichenor's website:
http://www.sinucare.com/~sinucare/physicians/listings/l0120.shtml


 Articles:
 http://sinucare.com/news.php

 About SinuCare:
 http://sinucare.com/content.php?PAGE=ABOUT
 "SinuCare has developed a sinusitis and sinus pain treatment program
available to its  nationwide, credentialed sinusitis physician
network, consisting of approximately 150  members. Often, a
multi-disciplinary approach, consisting of an Otolaryngologist,
Allergist, Infectious Disease, and Radiology expert, are employed to
effect the best outcome for the chronic sinusitis and sinus pain
sufferer."

 Locate a sinus care specialist:
 http://www.sinucare.com/content.php?PAGE=PHYSICIANS



============================
MORE ABOUT FUNGAL INFECTIONS
============================

"Mayo Clinic researchers say they have found the cause of most chronic
sinus infections -- an immune system response to fungus. They say this
discovery opens the door to the first effective treatment for this
problem, the most common chronic disease in the United States. An
estimated 37 million people in the U.S. suffer from chronic sinusitis,
an inflammation of the membranes of the nose and sinus cavity. Its
incidence has been increasing steadily over the last decade. Common
symptoms are runny nose, nasal congestion, loss of smell and
headaches. Frequently, the chronic inflammation leads to polyps, small
growths in the nasal passages that hinder breathing."

"Fungus allergy was thought to be involved in less than 10 percent of
cases. The new studies indicate that, in fact, fungus is likely the
cause of nearly all of these problems. And it is not an allergic
reaction, but an immune reaction. The disease process in sinus
patients, in sensitive individuals, the body's immune system sends
eosinophils to attack fungi and the eosinophils irritate the membranes
in the nose. As long as fungi remain, so will the irritation."

"Antibiotics and over-the-counter decongestants are widely used to
treat chronic sinusitis. In most cases, antibiotics are not effective
for chronic sinusitis because they target bacteria, not fungi. The
over-the-counter drugs may offer some relief of symptoms, but they
have no effect on the inflammation. Thousands of kinds of single-cell
fungi (molds and yeasts) are found everywhere in the world. Fungal
spores (the reproductive part of the organism) become airborne like
pollen. Some people develop allergies to fungi. The new evidence from
the Mayo study suggests that many people also develop a different kind
of immune system response."

From "Study Implicates Fungus As Cause Of Chronic Sinusitis."  
http://www.mercola.com/1999/archive/fungus_cause_of_sinusitis.htm


Read "Researchers show chronic sinusitis is immune disorder;
antifungal medicine effective treatment."
http://www.scienceblog.com/community/modules.php?name=News&file=article&sid=2513



===================================
NEW HOPE WITH NEBULIZED ANTIBIOTICS 
===================================

Nebulized, or inhaled, antibiotics are proving to an effective method
of treatment for patients who have recurring sinus infections. Rather
than circulating through the body (as in pill form), the medication is
delivered directly to the sinus tissues.

Some excerpts from a Stanford study follow: 

"Three years ago, Joanne Clark was so miserable from recurring sinus
infections and the antibiotics used to treat them that she felt ready
to give up. Despite three surgeries, Clark, a resident of Lodi,
Calif., continued getting sinus infections every two to four weeks.
The painful headaches and feelings of exhaustion, not to mention the
severe nausea from oral antibiotics, forced her to quit her job as a
physical education teacher. "I felt horrible," she said. "I had
headaches all the time. I had no energy. I didn?t want to live a life
like this."
 
"Clark eventually came to Stanford Hospital & Clinics where Winston
Vaughan, MD, an otolaryngologist, sinus surgeon and director of the
Stanford Sinus Center, suggested she participate in a clinical trial
of an innovative new treatment. Instead of taking antibiotics in a
pill, Clark could breathe them into her sinuses using a nebulizer - a
machine that converts medication from a liquid into an inhalable
mist."
...

"After taking the nebulized antibiotics twice daily for three weeks,
Clark experienced significant relief....Most of the other study
participants saw similar benefits from nebulized antibiotics. Of the
42 patients studied - all adults who suffered recurrent sinus
infections after surgery - 76 percent reported "significant
improvement" in symptoms, confirmed through physical exams and sinus
endoscopies."
 
"Significantly, the patients who benefited from the treatment remained
free of infection for an average of 17 weeks, compared with six weeks
previously. Like Clark, they reported few side effects and improved
quality of life."

Read more....

"Stanford researchers study emerging treatment for chronic sinus
infections." News Release/ Stanford Hospital and Clinic (12/26/02)
http://www.stanfordhospital.com/newsEvents/newsReleases/2002/122002/sinusTreatment.html


Also read the study abstract: "Abstract: Nebulized Antibiotics for
Acute Infections in Chronic Sinusitis."
http://www.sinuspharmacy.com/studiesabstract01.html

==

The conclusion of a similar study follows:

"Following 3 to 6 weeks of treatment, 34 patients (82.9%) experienced
either an excellent or good response to treatment. Side effects were
infrequent, mild, and transient. We conclude that nebulized
antibiotics should be considered for all patients with chronic
sinusitis who have undergone functional endoscopic sinus surgery and
who have failed to respond to oral antibiotics or who do not tolerate
them."

Read "Abstract: Nebulized Antibiotics for the Treatment of Acute
Exacerbations of Chronic Rhinosinusitis," by Philip A. Scheinberg, MD
FACS and Alan Otsuji, PharmD.
http://www.sinuspharmacy.com/studiesabstract02.html
 


================================
LONG-TERM LOW DOSE ERYTHROMYCIN
================================

* Please note that this is a controversial treatment.

"A study in Otolaryngology and Head and Neck Surgery shows that
long-term low-dose erythromycin therapy helps to control persistent
chronic sinusitis after sinus surgery."

"Many previous studies show that you have to take antibiotics for a
long time to cure sinusitis. What is encouraging about this paper is
that the authors treated their patients, each day, for more than a
year with 250 mg of Biaxin, a potent erythromycin antibiotic, and 12
out of 17 patients improved dramatically. The doctors checked their
patients every three months for a year. After each patient had been
treated with Biaxin for one year, their saccharine transit time, a
measure of mucociliary transport, improved. This test measures the
ability of the cilia lining their noses to clear mucous and pollution
from the nose. Also an Endoscopic nasal examination showed that there
was marked improvement in the linings of their noses. They also had an
improvement in being less stuffy, clearing their sticky secretions
faster, and having far less mucous dripping from their noses. They
also had far fewer and less severe headaches. The researchers said,
"The present study suggests that long-term, low-dose treatment with
erythromycin antibiotics is effective in persistent chronic sinusitis
that does not respond to sinus surgery or systemic steroid/antibiotic
treatment."

* "However, this is just one study and is controversial; this
treatment is not accepted by most doctors. Discuss it with your
doctor."

From "TREATMENT OF CHRONIC SINUSITIS," by Gabe Mirkin, M.D. (7/18/2002)
http://www.drmirkin.com/morehealth/1254.html

The study referenced in the article is "One-year low-dose erythromycin
treatment of persistent chronic sinusitis after sinus surgery:
Clinical outcome and effects on mucociliary parameters and nasal
nitric oxide." Otolaryngol Head Neck Surg 2002;126:481-89




OTHER HEADACHES
***************

Certain conditions can lead to headaches that present with pain upon
coughing, bending over and sudden jarring of the head. Please
remember, however, that you did have an MRI with resulted in clear
findings! Nevertheless, there is no harm in exploring other causes,
since MRI's are not perfect.

 
Intracranial pressure
=====================

"Patients with intracranial mass lesions, pseudotumor, obstructive
hydrocephalus, or other disorders that may result in traction on
intracranial pain-sensitive structures, may complain of headache that
need not be severe, but is exacerbated by Valsalva, cough, bending
over, or driving over a bump. "Traction" symptoms may accompany
migraine, but only at the height of a severe headache. Traction
symptoms in persons with persistent mild headaches should arouse
concern."

(The article goes on to cover other common types of headaches. I
recommend you read through each type to identify any common symptoms)

Read "Headache and cranial neuralgia: a synopsis," by Edward Valenstein, M.D.
http://www.medinfo.ufl.edu/year2/neuro/cranial_neuralgi.pdf



Migraines often mistaken for Sinus headaches
============================================

Please read "Migraine Mix-up, by Melinda T. Willis. ABC News.
http://www.nti-tss.com/SinusHeadache.html 



Pseudotumor Cerebri 
====================

"The common symptoms are headache, dizziness and impaired vision.
Headache is often worse on awakening, and can be intensified by
coughing, laughing, bending over, crying, and increased physical
activity

Read "Pseudotumor Cerebri Details."
http://home.sprynet.com/~sondra/ptcfacts.html

Also read "Pseudotumor Cerebri" for a good overview of this condition
(doesn't sound like you)
North American Neuro-Opthamology Society.
http://www.nanosweb.org/patient_info/brochures/PseudotumorCerebri.htm



Poor Posture and forward head can lead to chronic tension headaches
===================================================================

"Abstract: Tension-type headache, often accompanied with dull pains
originating from the occipital area, shoulder stiffness etc., is the
headache caused by ischemic muscle contraction, which must be
distinguished from those having psychologicalor depression-type
pathogenesis. Headaches in patients with tension-type head-ache begin
often in bending down posture or during a night sleep with a high or
hard pillow. Those patients have the tendency of having a slender and
long neck and problems with cervical angulation or cervical
instability. It is important to strengthen the neck muscles by
exercising the abdominal and back muscles and also to try to maintain
the correct, straight posture in daily life. Medical treatment is
necessary for those with hypotension or anemia, and neuroleptics are
effective for headache caused by stress."

Please read "Tension-Type Headache - Its mechanism and treatment," by
Manabu SAKUTA. JMAJ 47(3): 130-134, 2004
http://www.med.or.jp/english/pdf/2004_03/130_134.pdf



Cough Headache
===============

"Cough headache are characterized by transient, severe head pain upon
coughing, bending, lifting, sneezing, or stooping. The incidence of
serious intracranial structural anomalies causing this condition is
about 25%; the Chiari malformation is a common cause. Thus, MRI is
indicated for most patients with cough headache."

"Causes of new onset headache and clinical features." The Doctor's Lounge.
http://www.thedoctorslounge.net/clinlounge/diagnosis/pain/headache.htm

=

"Coughing, sneezing, laughing or bending over may cause this type of
headache, most likely by increasing blood pressure in the veins in
your head. The headache typically comes on suddenly and lasts for a
few seconds to several minutes. The pain is often described as sharp
or stabbing and is typically located on both sides of your head and at
the back of your skull."

"You're most likely to experience this type of headache if you're age
40 or older and male - these headaches affect roughly three times as
many men as women. If you experience such headaches, it's a good idea
to see your doctor - particularly if they're frequent, severe,
long-lasting or represent an increasing pattern."

"Your doctor may recommend a magnetic resonance imaging (MRI) exam.
This exam can help determine whether you have a  *primary cough
headache, which isn't serious,*  as opposed to another sort called a
secondary cough headache. Secondary cough headaches can occur as a
result of serious problems, including brain tumors and brain
malformations."

Read "Unusual headaches." From MayoClinic.com (Special to CNN.com) (Feb 2004)
http://www.cnn.com/HEALTH/library/HQ/01574.html

=

Please read "Chiari-Associated Exertional, Cough, and Sneeze Headache
Responsive to Medical Therapy," by M. Gabriella Buzzi, MD, PhD*; Rita
Formisano, MD, PhD; Claudio Colonnese, MD; Francesco Pierelli, MD.
Headache. 2003 Apr;43(4):404-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12656713&dopt=Abstract
 

===


 I have given you a lot of information to wade through. Hopefully, the
resources I have supplied will provide some avenues for you to pursue
and talk over with your doctor.

 If I can provide further clarification, please do not hesitate to let
me know. I will try to assist further if I am able.

 Headaches are no fun. I wish you the absolute best for a speedy recovery!
  
Sincerely,

umiat


Google Search Strategy
chronic sinus infections after surgery
fungus AND sinus infection
W.S. Tichenor, M.D.
"tractions symptoms" AND headache
primary cough headache
allergies and headache
medications for sinus headaches

---

Request for Answer Clarification by tpmeyer-ga on 14 Apr 2004 08:41 PDT

Umiat,

Thanks very much for the time and effort you put forth, and for the
well wishes.  I really appreciate that.   I'm thinking now that I
should have perhaps been more explicit in that I was hoping to get an
answer, rather than information.  Most of the links you've presented
I've already been to, and didn't find them particularly helpful.  My
frontal sinus was obliterated, so the links to the recurring infection
weren't germane.

I thought quite a bit about how much I was willing to pay for an
answer, and I chose $100 rather than $5 or $10 because I was hoping to
avoid the "10 dollar response", and get someone with special knowledge
or experience, or an uncle who was an ENT and just had the exact case
and knew how to answer my question, or something along those lines.  I
exepcted that most likely the question would go unanswered, since it
is quite a difficult case, but in the event that someone out there
actually did know the answer, or an identical sounding case which was
resolved, I'd have been delighted to pay the $100 for it.

I hope you will agree that your response isn't quite a $100.00 answer.
 I don't mean to offend you, as I really do appreciate your efforts.
If you still believe that you've answered this question adequately,
please let me know.

Warm Regards,

tpmeyer

---

Clarification of Answer by umiat-ga on 14 Apr 2004 14:58 PDT

Hello again, tpmeyer!

I'm sorry you are disappointed with my answer. I spent over 8 hours
researching and compiling the information, and felt my work would help
to lead you closer toward obtaining a proper medical diagnosis.
Unfortunately, I had no way of knowing that you had already viewed the
same material, or that you expected a researcher to actually supply a
medical diagnosis for you. No researcher can provide that - in fact,
it is against the Google Answers Terms of Service.

Please see the Terms of Service - Not Professional Advice
http://www.answers.google.com/answers/termsofservice.html

In my clarification request I tried to be very clear about researcher limitations:

"I must reiterate that researchers cannot provide a diagnosis. It is
impossible to say definitively "what is causing this headache, and how
you can make it go away?"

When I pointed out that I had information pertaining to recurrent
sinus infections after surgery and you did not specify  that you had
no interest in further information along those lines, I assumed that
you were receptive to the information I could supply.

However, due to your belief that the sinus infection might have
actually been a "red herring," I also presented a list of other types
of headaches that might be causing your symptoms. One type of headache
I did mention was the "Cough Headache", which presents with symptoms
very similar to your own. However, since you had a normal MRI, it is
merely another option for consideration.

=

Upon further research, I have discovered one other "possibility" for
your continued headache pain. Occasionally, frontal sinus obliteration
does not completely eradicate the infected mucosa. It is possible that
you have now developed a mucocele, which can indeed lead to continued
frontal sinus pain. In fact, the following article describes mucoceles
as "a water balloon from hell."
http://www.ivillagehealth.com/experts/ent/qas/0,,242110_173878-3,00.html 

 
The following abstract provides some information on mucoceles after
obliteration of the frontal sinuses:

OBJECTIVE: To evaluate the effectiveness of the modified endoscopic
Lothrop (MEL) procedure for the management of failed osteoplastic flap
(OPF) with obliteration of the frontal sinuses. SETTING: Adelaide
University Academic Hospital Complex. STUDY TYPE: Prospective case
study of 16 patients presenting with symptoms after OPF with
obliteration of the frontal sinuses. MATERIALS AND METHODS: Sixteen
patients presented with symptoms of frontal sinus pain after having
previously undergone OPF and fat obliteration of the frontal sinuses.
All patients underwent computed tomography scanning; 13 underwent
magnetic resonance imaging scanning, and 6 underwent a bone scan with
technetium to exclude frontal osteitis. All patients underwent
exploration of the frontal sinuses by way of the MEL procedure.
RESULTS: Fifteen patients were found to have a frontal sinus mucocele,
whereas one patient had no mucocele with only new bone and fibrous
tissue found at the MEL procedure. Twelve of the 16 patients with
mucoceles had resolution of their frontal headaches, with 15 having a
patent and healthy communication between the mucocele and the nasal
cavity. The one patient without a mucocele continues to have frontal
pain. One patient underwent a successful MEL procedure but had
persistent symptoms until a supraorbital ethmoid mucocele was removed
at a revision procedure. Two other patients continued to have frontal
headaches and pain despite a healthy ostium into the frontal sinus
mucocele. CONCLUSIONS: MEL is a viable alternative to revision OPF for
symptomatic patients who are shown to have a mucocele of the frontal
sinuses.

From "Modified endoscopic lothrop as a salvage for the failed
osteoplastic flap with obliteration."Wormald PJ, Ananda A, Nair S.
Laryngoscope. 2003 Nov;113(11):1988-92.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14603061&dopt=Abstract

==

 I again want to stress that since GA is not an arena for obtaining a
medical diagnosis, I hoped and assumed that the information I could
provide would help you follow up on various suggestions with your
physician. Had you stated in your original question (or clarification)
that you were looking for the resolution to an "identical sounding
case," or that your were looking for "an
answer, rather than information," I would not have proceeded. 

 I do understand your frustration concerning a definitive diagnosis
for your current headaches (especially after all you have been
through). However, I do disagree that my answer was a "10 dollar
response." I take my position as a GA researcher very seriously and I
sincerely hope I will never try to short-change a customer by
providing anything less than comprehensively researched information as
an answer to a question.

Respectfully,

umiat

A for effort.  I guess I take the "answer" in "Google Answers" too
literally.  I wanted an answer, and even the researcher agrees that I
did  not get an answer.  Perhaps  my question was "unanswerable', but
if that is the case, it seems best to leave it unanswered, which would
have been my preference.  Thanks very much for the effort.

Warm Regards,

tpmeyer

I have come across many people with constant headaches. First off, all
of those antibiotics that you have taken will kill off the beneficial
bacteria in your intestines. Many times this will lead to a yeast
overgrowth (candida infection) the yeast will produce many toxins.
Supplement with probiotic bacteria. The best I know of is Primal
Defense from Garden of Life. You may also get a formula specific for
yeast infection at any health food store. Hidden food allergies can
also cause headaches. Try visiting http://www.dadamo.com Eat Right for
Your Type. How people with different blood types react to different
foods.
Also consider chiropractic care. http://www.chirohelp.com One of the
safest forms of health care available.