I have normal vision. What can be the cause of my headache?

Question

Hello doctor,

I am suffering from throbbing, dull pain in my left eye, which is shooting down to the left nostril. I feel pressure when I bend forward, and also some discharge from the nose with a salty taste. I am getting the pain while watching television and when working on the computer.

I am having a good sleep, and my vision is also normal. But when I press my forehead just above my left eye, I feel throbbing pain. I have consulted two neurologists. They did not recommend any scan.

One suggested Gabapentin and another Sibelium 10 mg once a day at night for a month. Both asked me to do some physical work like closing my eyes, stretching my hands, walking, and stepping one foot after another. What is my problem?

Kindly explain.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed all the details you posted, and the differential diagnosis for your problem is as follows. First is frontal sinusitis, as you have mentioned, pain when you press above the left eye. Normally, the frontal sinus drains into the nasal cavity in an upright posture, so the headache tends to be worse in the morning and decreases as the day progresses, often referred to as an "office headache."

To diagnose this condition, an X-ray of the paranasal sinuses (PNS) water view is needed. Second is migraine. The neurologists who started you on Gabapentin or Sibelium likely considered migraine as the cause, as these medications are commonly used for migraine treatment.

In case of migraine, the headache is one-sided, throbbing, lasts for more than 4 hours, and decreases with rest. The history of photophobia or phonophobia may be present. Also, nausea or vomiting at the time of the attack. Treatment for migraine involves both acute attack management with NSAIDs like Naprosyn (Naproxen) and preventive therapy using medications such as beta blockers, Sibelium (Flunarizine), Gabapentin, or Topiramate.

The diagnosis of migraine is made clinically, and other potential causes must be ruled out. If the headache persists or worsens, a CT scan of the brain may be necessary to rule out intracranial pathology. Third is a refractive error, so it is advisable to get your eyesight checked. Fourth is tension headache, although this possibility seems unlikely in your case. Lastly, cluster headache is another consideration.

These headaches are also unilateral but occur in clusters, with attacks happening at the same time of day for several days, followed by symptom-free intervals lasting several months before the attacks start again. During a cluster headache, symptoms such as red eye, tearing from the eyes, and a runny nose may be present. A complete neurological examination would be necessary to further evaluate this possibility.

I hope this helps you.

Take care.

Answer 2

Hello,

Welcome back to icliniq.com.

I suggest the following medicines-

Sibelium has side effects and drug interactions.

Than Gabapentin, I suggest Topiramate 25 mg twice daily. Consult your specialist doctor, discuss with him or her, and take the medicine with consent.

Use Naxdom (Naproxen) 250 mg at the time of the acute episode, if it is severe.

Try to maintain a headache diary and note down the frequency of occurrence. Also, write how many times you had to take Naxdom due to its severity.

Avoid stressors such as sunlight exposure, tension, prolonged TV watching, and eating chocolates and groundnuts.

For further information, consult an internal medicine physician online.

Take care.