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Reader's Mail: Appropriate Diagnosis Is Key to Solving Health Problems

Q. For the past year, off and on, and for the past three months continuously, I have had headache/dizziness related to the sensation of clogged ears. Per the advice of an ear, nose and throat specialist, I  do a saline sinus rinse, take a dose of Flonase, and I breathe steam with eucalyptus oil on a daily basis. I put a humidifier on my CPAP. I have also tried Sudafed, Claritin and Coricidin with no relief.  I am miserable, and the condition disturbs my sleep. Is there any hope for me? 

A. If I understand your question correctly, you are looking for a neurological explanation to your headaches and “dizziness.” A successful treatment plan must begin with a precise diagnosis.

First, it is important to describe “dizziness” more precisely. This term sometimes could mean lightheadedness, or it could mean vertigo or a spinning sensation. Lightheadedness is never due to ear problems, but vertigo can be caused by ear problems or by problems in the central nervous system. Lightheadedness could relate to a reduction in blood flow to the brain, and this needs to be evaluated.

Next, your headaches need to be characterized. So-called “sinus headaches” are commonly misdiagnosed in patients who actually have migraine or cluster headaches. Migraine patients can have spinning sensations or vertigo as part of their migraine, and a small percentage of migraine patients, and a larger percentage of cluster headache patients, experience a sensation of stuffiness of their nose or tearing in their eyes during an attack.

In summary, a more precise diagnosis is necessary before launching a treatment plan. Treatments for sinus problems or allergies are generally ineffective in patients with migraine or cluster problems. You should see a headache specialist and, above all, don’t give up hope.

Edmund Messina, M.D. 
Director, Michigan Headache Clinic
East Lansing, Michigan

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