OpenHealth Q&A

Persistent Headache and Dizziness: Sinus Issues or Beyond?

Subject: 40-year-old assigned female at birth, now a trans man. Current Medications: Trintellix, lisdexamfetamine, metoprolol, atorvastatin, pantoprozole, testosterone cypionate, Singulair, meclizine, azelastine nasal spray, over-the-counter allergy relief medicines, Emesetrol. Lifestyle: No use of recreational drugs or alcohol. Medical Background: Diagnosed with asthma, environmental allergies, IBS, GERD, high cholesterol, and hypertension. I have consulted both my general practitioner and an allergist regarding my ongoing issues, and a sinus CT scan has been completed. Summary: Experiencing a daily headache localized on the right side of my head, accompanied by dizziness and occasional nausea or vomiting. There is no evidence of an obvious infection, and conventional allergy medications or pain relievers haven't been effective. What might be the underlying cause, and what further diagnostic actions should be considered? Since mid-February of this year, I've been suffering from headaches on the right side of my head daily. The pain isn't constant and can fluctuate in intensity from mild to moderate. Typically, I experience a pressure-like sensation or throbbing discomfort, along with sharp, stabbing pangs at times. Over the months, the discomfort has intensified somewhat. Generally, the ache stretches across a wide area, starting at my temple and reaching about two inches behind my ear. I occasionally experience pressure or discomfort in my right sinus area. Over-the-counter pain relievers have yielded little to no benefit; however, DayQuil has provided the best relief, though I find that using a percussion massager on my head where it aches seems the most effective. Am I risking damage to my brain cells? Not sure, but it truly helps. Starting around May, I began experiencing episodes of dizziness that occur daily with varying intensity, whether I'm having a headache or not. My doctor prescribed meclizine, which has been somewhat effective, although I find myself taking it as many as three times each day. In addition, I began noticing an unusual sensation in my throat—almost as if triggering a gag reflex or the stretching feeling during a deep yawn. While I experience nausea infrequently, I did vomit once during an intense episode. In the last few weeks, I've also faced sporadic symptoms of watery eyes and a runny nose, occurring on one side or both at times. The nasal discharge is generally clear and thin, and these symptoms appear to worsen if I forget to take my allergy medication at night. A complete blood count (CBC) was conducted in early March, indicating a white blood cell count of 11.6, which for me typically falls between 9.6 and 12. The results from the CT scan were not alarming according to my physician. The radiologist noted: "There is mild mucosal thickening observed in the left inferior maxillary sinus along with a trace of thickening in the right inferior maxillary sinus. A partial opacification of a left posterior ethmoid air cell is noted. The frontal sinuses show inadequate aeration. Remaining ethmoid air cells and sphenoid sinuses maintain a normal air pattern. The ostiomeatal units are clear. The middle meatus appear normal. There is slight left deviation of the nasal septum. The intraorbital contents are intact and visualized facial bones show no abnormalities, along with unremarkable soft tissues of the face. The posterior cells are well-aerated." From my doctor’s brief note and the radiologist's observations, it seems improbable that my sinuses alone are causing all of these symptoms. What other conditions should we explore? What steps are likely to be taken next to identify the root cause?

Answers (1)

8/7/2025, 6:50:57 PM

OpenHealth AI

You're experiencing a complex mix of symptoms, including persistent right-sided headaches, dizziness, and occasional nausea. While it seems that your sinus issues are ruled out as the primary cause based on the CT scan results, it’s important to further explore other potential underlying conditions.

Understanding Your Symptoms

Your symptoms could relate to several factors including, but not limited to:

• Migraine or Cluster Headaches: The nature of your headaches—throbbing, localized pain, and intermittent pressure—could suggest these types of headaches, which are known to cause nausea and dizziness.
• Vestibular Disorders: These can lead to dizziness and sometimes headaches due to balance issues originating from the inner ear.
• Medication Side Effects: Given your current medication list, it’s worth considering whether any of them might contribute to your symptoms. For instance, some antidepressants can have side effects that include dizziness or headache.
• Allergies or Sinusitis: Although the CT scan was not alarming, your ongoing allergic symptoms could still contribute to headaches or pressure sensations.
• Gastroesophageal reflux disease (GERD): Given your history of GERD, it might sometimes cause sensations in the throat that could trigger nausea.

Next Steps for Investigation

Here are some prioritized actions you can consider to help identify the root cause of your symptoms:

1. Headache Diary: Keep a detailed record of your headaches, including frequency, duration, intensity, any associated symptoms (like nausea or dizziness), and responses to treatments. This can help identify patterns and triggers.

2. Consult a Headache Specialist: A neurologist who specializes in headaches could provide further evaluation and possibly order additional imaging studies or tests to clarify whether you're experiencing migraines or other headache types.

3. Review Medications with a Healthcare Provider: Schedule a discussion with your prescribing doctor about your current medications. Consider whether any adjustments might alleviate your symptoms, especially focusing on the potential side effects of your medications.

4. Vestibular Assessment: If dizziness remains a significant concern, a referral to an ear, nose, and throat (ENT) specialist for a vestibular assessment might be helpful. They can evaluate the inner ear and balance systems.

5. Allergy Management: Since you're experiencing allergy symptoms, assessing your allergy treatment plan with an allergist might be worth considering. They can evaluate whether further management is needed, such as allergy testing or reconsideration of your current medications.

6. Hygiene and Triggers: Implement general self-care practices such as staying hydrated, maintaining a consistent sleep schedule, and avoiding known headache triggers (like certain foods, stress, or lack of sleep).

7. Regular Follow-Up: Ensure regular follow-up appointments to reassess your symptoms and the effectiveness of any changes made in your treatment plan.

Reassurance

It’s understandable to feel concerned about the persistence of your symptoms, but with structured evaluation and management, many patients find relief and can improve their quality of life. Please continue to communicate openly with your healthcare team, and don't hesitate to reach out if your symptoms worsen or if you have new concerns.