Q. What causes constant headaches with fatigue and eye strain?

Answered by
Dr. Dheeraj Kumar Jonnalagadda
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Nov 29, 2019 and last reviewed on: Nov 30, 2019

Hi doctor,

For about four months I have had painful facial, sinus headaches, fullness and fluid in both ears and bouts of vertigo and blurred vision. I have no mucus from the nose and had no recent colds or URI. My doctor prescribed antibiotics for ear infection and Flonase and Cetirizine for allergies and inflammation. Symptoms improved for a short time but then came right back. My GP ordered a CT scan of the sinus and no fluid or sinus infection was seen, but I have mucosal retention cyst in the left sphenoid sinus and a nasal septal spur, deviation to the left. The headaches are almost constant and causes fatigue and eye strain. I have tried neti pots, steam, Ibuprofen and I only get minimal relief. I am not sure what to try next.

Dr. Dheeraj Kumar Jonnalagadda

Allergy Specialist Otolaryngology (E.N.T)


Welcome to icliniq.com.

The problem you are suggesting is facial headaches which may be due to many reasons:

1. Is this headache on one side of the face or on both the sides of face? Usually, sinusitis is presented on both sides and migraine presents on one side.

2. Please upload the scan to see the disease, sphenoidal retention cyst may not always present with headaches and if it is fungal ball in sphenoid, it can definitively cause headaches and has to be approached immidiately.

3. How often do you have symptoms of allergy like sneezing, nasal discharge, watering of eyes?

The above answers will help us to come to a conclusion and also will let me give you a permanent closure to the problem.

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Thank you doctor,

I do not have the CT scan itself only the doctors findings which read, "mucosal retention cyst in the left sphenoid sinus and a nasal septal spur/deviation to the left. These anatomical findings are benign, but can cause sinus issues".

The headache is more like a front facial headache, even on both sides, behind the eyes, nose, and maxilla. I am having some blurry strained vision. I have not had any sneezing, nasal discharge, or watering of eyes. Just the ear fullness and headaches. My doctor does not think I should see an ENT until I take another round of antibiotics but I do not believe I have an infection.

Dr. Dheeraj Kumar Jonnalagadda

Allergy Specialist Otolaryngology (E.N.T)


Welcome back to icliniq.com.

So, coming to your complaint pattern, these can be acute episodes of sinusitis which reduce with antibiotics and hence are not shown in your CT scan. So, first your ear is affected because of your sinus infection, so it can be either acute or serous otitis media which can be confirmed by an ear otoscopy or endoscopy.

As soon as the above ear infection subsides, I will suggest you to do regular nasal washes and use a rubber catheter and fill normal saline in it and flush it in your nose so that it enters your sinuses, cleans it and comes out every day followed by using Flonase nasal spray. This will ideally almost complete your treatment without any further medications.

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