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Headache thought to be caused from sinusitis, developed

worst headache of my life...
headache thought to be caused from sinusitis, developed worst headache of my life last Wednesday went to ER had migraine protocol which helped but then headache returned just not as severe went back to ER one more time for migraine protocol and helped but as soon as the meds wear off headache back. I have had a 5 full days of clarythromycin and yesterday was switched to moxifloxacin. I have been in bed non-stop as soon as I rise my headache starts getting worse. Advil and tylenol do seem to take the edge off the headache but it never fully goes away unless I am lying down. I have been eating and drinking ok, no nausea, I had a fever over a week ago none sense. I had a head CT that just showed sinusitis, lab work slightly elevated WBC but all else normal. Was offered an LP but since my headache responded so well the first time to migraine protocol we didn't do. Neurologically I have no deficits, headache is a bit photophobic, no nucal rigidity but my neck feels tender at the base of my skull. I do still have a bit of puss draining down the back of my throat, my sinuses feel completely clear though. I have been sick for an extended period of time, highly unlike me I am wondering what else I could be doing to get this better or if I should be worried about letting it go on so long. I am a nurse practitioner so I have gone over all the differentials that I know of and I don't feel like I am worsening just not getting any better.
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Answered in 1 hour by:
10/16/2017
Dr. Huynh
Dr. Huynh, Board Certified Physician
Category: Medical
Satisfied Customers: 76
Experience: Assistant Director / Medical Officer at Howard University
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Hello, I'm Dr. Huynh, a board certified physician. Please allow me a moment to review your question and I will reply shortly.

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What field of work are you currently in? Any recent exposures that we should consider?

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Customer reply replied 1 month ago
I work in primary care, I do cover urgent care walk in daily. No travel history for me. All of this started about 16 days ago with a bad URTI I have asthma so it did exacerbate it so I took prednisone 50 mg x three days the upper resps. symptoms seemed to clear except for my sinuses. I started doing sinus rinse BID as well as Avymys after three days of that my sinuses seemed clear. Then the next day my headache got very bad as described to you already. Today I am actually feeling a bit better after waking through the night to take advil twice, I took last dose about 3 hrs ago and my headache is actually pretty tolerable. Movement and being upright seem to have been the big cause of it getting worse.

I'm glad to hear that you feel a little bit better! Where is the headache located? If you press on your maxillary and frontal sinuses bilaterally, does it significantly increase the pain?

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Customer reply replied 1 month ago
No it is more temporal and across the upper part of my forehead, into my jaw even and behind my eyes. At it's worse it found it hard to move my eyes without pain, eye pain no longer today. No throbbing, no stabbing just a constant ache that worsens with movement and being upright.

If the sinuses don't hurt when you press on them, the headache you're experiencing may be caused by something else. Do you have a history of migraines or other types of headaches?

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Customer reply replied 1 month ago
I never get headaches of any kind. Once in a while if sick but usually I have been pretty well.
I am certain this all for sure started with sinus infection (bacterial vs viral) just due to the amount of draining I was having. but treated w/ clarythomycin x 5 days and switched to moxifloxacin yesterday. (Wonder if the moxifloxicin is the reason I feel a bit better today I will be able to tell once the advil and tylenol wear off). I still have a bit of drainage down the back of my throat but sinus feels clear there was a small blood clot in it today. I don't have a sore throat no cervical LN, no fever.

I don't doubt that your headache was triggered by your recent sinus infection! Hopefully it will improve as the infection resolves. Clarithromycin and moxifloxacin are good antibiotics for it as you know. Did they give you any flonase to help decrease inflammation and post nasal drip?

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Customer reply replied 1 month ago
I have Avymys which I was using with he BID sinus rinse. I stopped the rinse and the spray the day my headache got so bad that I had to go to ER, I was honestly a little frightened to keep using it. Since I don't seem to have much post nasal drip I didn't restart it.

Fluticasone nasal spray does have a side effect of headache but it's not as common. I would keep a close eye on your symptoms and see if the headache improves with your course of moxifloxacin. If it continues to do so, then no further testing would be necessary. But, if it does not improve after 2 full courses of antibiotics, I think you should continue trying to find the cause. You could try a triptan for example to abort the headache or getting an MRI for higher specificity.

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Customer reply replied 1 month ago
that all sounds reasonable, my next step was to ask for a triptan to try, I have a doc appt tomorrow afternoon booked just in case I still feel this way tomorrow. Thank you.

You're welcome. If you have any other questions, please let me know. Otherwise, please take a moment to rate me a 5 or let me know how I can improve. I hope you feel better soon!

Dr. Huynh
Dr. Huynh, Board Certified Physician
Category: Medical
Satisfied Customers: 76
Experience: Assistant Director / Medical Officer at Howard University
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Customer reply replied 1 month ago
Sounds good I will let you know how I feel tomorrow, I'm really looking forward to feeling better. Thanks

I'll be here and look forward to hopefully good news!

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Dr. Huynh
Dr. Huynh
Dr. Huynh, Board Certified Physician
Category: Medical
Satisfied Customers: 76
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Experience: Assistant Director / Medical Officer at Howard University

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