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Treatment for throbbing headache with pain behind eye.

Resolved Question:

What could be causing my headache?

Around 2 weeks ago I suffered allergy like symptoms e.g. itchy nose, headache and pain in the upper left nasal cavity and behind the left eye. However I did not suffer from sneezing, runny nose or congestion. Symptoms were worse early morning and usually woke me up very early. Any discharge that I blew from my nose was clear.

I do suffer from hay fever from time to time and I usually take antihistamines to relieve the symptoms however this time they had no effect.

The weather at the moment is warm and dry and there are a lot of trees in flower which usually triggers my allergy symptoms, especially when it is windy.

The symptoms persisted so I visited a doctor for a checkup. He looked up my nose and said I had swollen dry and inflamed nasal passages. He prescribed a steroid spray, decongestants and pain medication.

5 days later the symptoms did not improve so I visited the doctor again, this time he put me on a course of Roxithromycin and Ibuprofen for my pain.

A week later the pain behind my eye subsided however my nasal cavities still felt dry and slightly throbbing with mild pain. My headache pain has moved to my forehead and temples and is quite intense. The headache is continuous and only relieved by Ibuprofen.

I visited the hospital this time for a consultation, they couldn't see anything wrong from the physical examination. They did an x-ray and couldn't find any blockages or anything similar to sinusitis.

They prescribed a different steroid spray "nasonex", antihistamines, mar nasal spray and paracetamol. They told me to return in a week and if headache symptoms were still there they would refer me to a migraine doctor.

I have no history of migraines in my family and I very rarely get headaches, this is the first time I have experienced a continuous headache and sinus pain like this.

I generally feel unwell and it's making it difficult for me to work. I'm wondering if there could be an infection somewhere else that needs treating with a different type of antibiotic. Any info would be appreciated.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Thank you for choosing DoctorSpring.

Do you have these headaches throughout the day ? Or is it more in mornings ?
Also does the pain increase when you stoop down / bend ? Is there a feeling of fullness and throbbing when you bend your head down ?
Is there pain if you press the bridge of your nose or temples ?

As of now is this headache your only symptom ?

You can reply as a followup
Thank you

Patient replied :

Thank you for the reply.

I have these headaches throughout the day. This morning I was woken up by the headache at 5am and it's been continuous up to now (4pm). I have just taken Ibuprofen and it has helped relieve the pain.

The pain increases very slightly when bending/stooping. There is a feeling of fullness and slow throbbing when I bend my head down.

I don't feel any pain when I press the bridge of my nose; however I feel a little pain when pressing my left temple over the vein.

In addition to the headache my sinus feels like it's dry, tight and throbbing. I also have a slight tightness in my upper chest, a little similar to the feeling I had as a kid when I had an infection from asthma, although not as bad.



Thank you for the information.

Migraine and Headaches of Sinusitis (or so called Sinus headaches ) often cause diagnostic confusion. However in your case the history of onset of the symptoms and the features are suggestive of Headache from ACUTE SINUSITIS.

I will list down my recommendations.

1.Opening up sinus to drain is important. Steam inhalation via nose twice daily can help in this.

2. Continue the anti allergic medication. However since its been over a week you need not use the steroid nasal spray

3. Use Ibuprofen only if really necessary.

4. Oral decongestants like ephedrine sulfate 25 mg, pseudoephedrine HCL 60 mg, phenylephrine HCL 10 mg etc can help, but might require a prescription.

4. The antibiotic chosen by your Physician is Roxithromyicn which is a Macrolide. These are not the first choice for Acute Sinusitis as there is high rates of resistance of S. pneumoniae . So if symptoms persists more than 48 hours you might need another antibiotic course of Amoxicillin-clavulanate, which is more suitable antibiotic.

Most of the cases of Sinus headache peaks over few days and then declines. Xray and Physical examination might not diagnose sinusitis. Do follow the recommendation. If the pain is persisting you will require further evaluation and treatment

Hope this helps
Feel free to ask follwoups
Thank you

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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