I have been suffering from post nasal drip and a

Patient

Q: I have been suffering from post nasal drip and a nagging head and facial pain on an almost daily basis since the last two years. The pain is restricted to the left side and rarely radiates to the other side. The areas that are affected by the pain are the bridge of the nose near the left maxillary sinuses, the left cheek, the top of the head and occasionally the back of the head. The pain is almost always accompanied by stuffiness/congestion in the aforementioned areas, post nasal drip, and a general feeling of discomfort in the chin. The post nasal drip and the pain go hand in hand; if there's no pain there's no post nasal drip either and vice versa. Sometimes there is also a very dull ache in the back of the neck which subsides after a few minutes. I have had a PNS X-Ray last month as recommended by an ENT specialist which has ruled out the possibility of sinusitis; the sinuses are clear and there's no deviation of nasal septum. So the doctor diagnosed my condition as allergic rhinitis and prescribed medication for the same. I took a tablet of Odimont LC every day for the last two months, but it hasn't proved effective at all.

What could be a possible cause for this condition? Is it neurological? People around me are speculating it's migraine but I don't have many of the symptoms commonly associated with migraine such as nausea and aura. On that note I had seen a neurologist a year ago, and he diagnosed it as pain caused by strain in the neck or something along those lines and prescribed Gabapin (100 mg) that didn't prove effective either.

Doctor

A:   Welcome to Ask The Doctor. We are here to help you.

Initially, if we look at your history, it looks like Sinusitis. But if I go in detail, it seems to me Cluster Headache. Moreover, you have clear X-Ray PNS. So, I have following diagnosis for you:
1.Migraine Headache.
2.Cluster Headache.
Migraine headaches are usually unilateral, associated with throbbing, vomiting sensations, photophobia and phonophobia.
Cluster Headaches are transient come for a few seconds and are associated with watering of eyes, redness of eyes, watering from the nose.
A clinical examination specially Neurological Examination, fundus examination are must to rule out any other Neurological problem which might also require Neuroimaging.
You should see your doctor.
He will classify the headache and if it is Migrainous, treatment would be with the drugs like Flunarizine, Propanolol, Amitriptyline.
Cluster headaches are usually resistant to treatment. In case of Acute Headache, we give Oxygen therapy, which helps in relieving the pain. For prophylactic purpose, Pregabalin helps to some extent.

I hope it helps.
Stay Healthy

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