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How should I manage nasal allergy with migraine?

Q: I am 33 years old and suffering from bronchial asthma and allergic rhinitis since the age of 10. I had high eosinophil in blood during childhood. The bone in my nose is also protruded. But asthma symptoms subsided. Yet nasal allergy, sneezing, headache continue to trouble me. I also have migraine four times a month. Two years back, I took a medicine for migraine for about 5 months (sibelium tab-nasal spray) under the supervision of a neurologist. I use the Asthalin inhaler and sometimes Cetirizine tablets help. But my main problem is headache, due to nasal blockage or severe migraine with nausea. I consulted a neurophysician, who suggested that I should go for a comprehensive test like a CT scan of brain, face, chest x-ray, ECG, ESR, CBP, etc. for treatment. Kindly evaluate my case and give advice regarding next course of action.

A:Your problems are Bronchial asthma, allergic rhinitis, deviated nasal septum and probable migraine. I am not sure if you have features of sinusitis (which at times can cause headache and needs to be differentiated from migraine). In fact, sinusitis is often diagnosed by lay persons or even by GPs in patients who have cough and cold or rhinitis (as in your case) quite often. Distinguishing headache due to sinusitis and migraine is very important because treatments are different. Migraine headaches have throbbing, pulsatile quality, usually occurs in half of head (may involve both halves at times), associated with nausea and vomiting and intolerance to bright light and loud sound. It typically increases with activity and makes the patient unable to carry on with his/her work. It usually lasts for hours. Migraine is a primary headache (meaning that there is no structural pathology in the brain) and usually CT/ MRI is normal. However, before being sure of migraine, the physician has to exclude serious intracranial pathology by considering certain specific symptoms and / or signs (so called red flags) by careful history taking and examination. If he feels that there are indeed red flags, some investigations may be requested. Nasal blockage can at times cause headache (usually due to acute / acute on chronic sinusitis). You need to check up with your ENT doctor. Radiological finding of sinus involvement (by X-ray, CT-sinus, MRI) is a common finding even in asymptomatic patients and always needs to be clinically correlated. Thus, my advice will be to get an opinion from a Neurologist, ENT specialist, Chest Physician (for asthma and allergic rhinitis) and get a comprehensive strategy for tackling your problems.

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