It seems to me that many pain patients have chronic problems with sinus headaches and such. Many times when evaluated by an ENT doctor, the patient will be told that the sinuses are clear and that they are not the source of their headaches. While this may be true on the surface, deep in the nasal passages are many sites that may become triggers for migraine type headaches. I used to get these when I was operating because of the lint from the surgical masks. I soon learned that I needed to place neosporin ointment in the nares of my nose. After endoscopic sinus surgery and antibiotics, my headaches cleared until I had my neck surgery, after which, my sinus problems came back. I had forgotten about nasal hygiene and supposed that my terrible headaches were due to neck surgery, or whatever. I have read that fibromyalgia patients have a very high incidence of sinus trouble, which may be partially due to allergens, ciliary dysfunction which is autonomic nerve dysfunction, or just poor hygiene due to pain. Whatever it is, there are a lot of nerves in the nasal vault that get irritated, dry up, get crusty, and even bleed. The nasal airway mucosa itself gets inflamed and infected very easily. Perhaps, it has to do with poor immune systems. The treatment that has worked best for me is nasal hygiene, or irrigation of the nasal passages, and treating the mucosa the same as if the one's facial skin had been irritated, scraped, or damaged; to keep it covered with an antibiotic ointment which treats bacteria, keeps the mucosa moist and clean, and promotes healing. It prevents the sinuses from have their openings blocked up and prevents the infection of sinusitis.

The method is no different than washing the dishes. Use a Saline spray such as OCEAN which is available in the supermarket. This gets off the big stuff before placing the cleaning compound, in this case, a triple antibiotic or Neosporin antibiotic. If one is allergic to the Neomycin component, use a double antibiotic such as Polysporin. Many ENTs will recommend Bactroban because it is water soluble. I don't like it because it is water soluble and will dissolve away before the mucosa can regenerate well. One can use a Q-tip applicator, or cotton tipped applicator. There is not much one can damage in the nose along the passage way, so I have become very adept at placing the ointment precisely where the pain source is that is beginning to trigger a migraine. Now, I can not tell someone on the internet to do this, so ask your own physician if you are not my patient. Usually the sorest spots are where the airway narrows more posterior, because the air has a greater velocity posteriorly (unless it is congested shut, which allows bacteria to fester in the sinuses because of poor drainage.)

 

 

 

	Mucosal Lining of the Nasal Passageway Becomes Dry and Crusty
	This shows the extensive innervation of these nasal linings and sinuses that carry pain to the head

 

Now , if one has animals or pets with danders that are irritating, you do not have to go and find a new home for the pet. You must, however, keep the animal out of the bedroom at night (which usually helps with sleep). I have used air filters in my bedroom for many years now. I also keep the carpets and sheets clean. You will have to do strict nasal hygiene to prevent the disabling "migraine-like" headaches. The bottom line is that nasal airway inflammation or CHRONIC RHINITIS can be very disabling, fatigue inducing, and most likely may result from any condition that alters the ciliary autonomic nerve function.

For physicians, you must look up the nose for every headache evaluation. I can pretty much bet that every time someone with a headache problem comes to the clinic after failing headache clinics, they will answer my question about whether anyone has ever examined their nose with a NO.

 

In summary,

Nasal Hygiene is carried out 2-3 times per day, especially before sleep

Learn to use tissues, and fingers and hands are never placed on face or around nose.

Use Ocean-type nasal irrigation. Attach a nasal pump to it for easier use.

Then use Afrin-type medication on a q-tip to decrease areas of swelling. Try not to spray it in the nose, so that you can avoid rebound congestion

Place neosporin ointment inside of nasal passages with a cotton tipped applicator.

Consult with your family doctor or an Ear, Nose, and Throat Doctor for any problems.

Remember to sleep, eat right, and avoid stresses to not trigger these headaches.