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 Neti pots, sinus disease, and migraines
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marfknox
SFN Die Hard

USA
3739 Posts

Posted - 04/06/2008 :  14:52:33  Show Profile  Visit marfknox's Homepage  Send marfknox an AOL message Send marfknox a Private Message  Reply with Quote
I've mentioned on SFN before that I suffer from migraines, and they have become much more of a problem ever since I started teaching full time and commuting to one of my jobs. I went to the doctor a couple months ago about this, got an MRI, and the results said that I had chronic sinus inflamation. My doctor told me (and other sources, which I looked up later on my own, confirmed) that migraines and sinus disease are often mistaken for each other, and she thinks I suffer from sinus disease. Okay, this sort of makes sense since working with little kids does increase the amount of mucus in my sinuses on a regular basis. My doctor recommended using over the counter meds such as Claritin when things get bad.

I hate taking medicine. I have a good reason, too; I'm terribly susceptible to side effects. So the next thing I did was research the crap out of various treatments for sinus inflammation. And ultimately I ended up paying $15. for a stainless steel neti pot. http://en.wikipedia.org/wiki/Neti_pot

After using the neti pot for a couple weeks, I did mention it to my doctor. She gave me a very funny look and asked me if it worked. I said, "I think so, but I haven't been using it very long yet and also I don't know how much could be placebo effect." At the word "placebo" she smiled and nodded gleefully at my skepticism.

However, it has now been a couple months, and I have yet to suffer from a nasty migraine that lasts for several days, such as those which were plaguing me in the fall and early winter. Could it be the neti pot works?

I looked up "neti pot" on skepdic.com and did a general search on the Internet with "skeptic" but so far haven't found anything debunking them. There's nothing that I see that is especially woo about their claims: salt water poured through one's sinuses helps clear them. It just seems, well, a little too easy that mixing salt and warm water and pouring it in one nostril and out the other once a day would actually work to stop excruciatingly painful headaches and light-headedness. But maybe that's not that weird.

Thoughts or more info?

"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong

Check out my art store: http://www.marfknox.etsy.com

bngbuck
SFN Addict

USA
2437 Posts

Posted - 04/07/2008 :  14:01:01   [Permalink]  Show Profile Send bngbuck a Private Message  Reply with Quote
Marf.....

My daughter has extremely troublesome sinuses and chronic infection. Her eent has advised her for years to irrigate regularly with a saline solution, and it certainly has minimized her problem. Another, medically suggested approach is to use a solution of hydrogen peroxide, which is as excellent topical antibacterial. You might want to ask your eent about that one!
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Dave W.
Info Junkie

USA
26001 Posts

Posted - 04/07/2008 :  16:07:23   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
I don't see anything particularly woo, either, but I question spending $15 when a large-bore syringe could be had for a couple bucks, tops (even a turkey baster would do the trick).

30 years ago I had a yoga book that included nice pictures of a guy with saline-soaked, inch-wide "floss" up one nostril and out the other.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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Dude
SFN Die Hard

USA
6891 Posts

Posted - 04/07/2008 :  18:07:32   [Permalink]  Show Profile Send Dude a Private Message  Reply with Quote
Don't fear the "side effects". Those are symptoms that people in clinical trials developed, almost always at a very low rate. Often there is no evidence to suggest a causal effect between those symptoms and the medicine under consideration. Sometimes its just the investigators being cautious.

So.

Try a nasal steroid (nasonex or flonase). As a person who has idiosyncratic reactions to some common medicines (not allergies), I've never had a problem with this med. It reduces sinus inflammation.

Saline irrigation of sinuses can clear them out, but it does nothing to deal with the underlying problem.


Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson

"god :: the last refuge of a man with no answers and no argument." - G. Carlin

Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth
Edited by - Dude on 04/07/2008 18:07:54
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bngbuck
SFN Addict

USA
2437 Posts

Posted - 04/07/2008 :  18:52:40   [Permalink]  Show Profile Send bngbuck a Private Message  Reply with Quote
Marf.....

Has your doctor identified the source of your chronic sinus inflammation? If it is allergenic in origin, antihistamines will help. Chronic inflammation which is not infectious should respond to topical steroids as Dude suggests. If there is infection present, antibiotics are in order, but several of the sinus cavities have practically no blood supply so it takes a lengthy regimen of antibiotics to finally penetrate to the infected area!

Ask your eent about a 3% solution of medical grade H202 as an irrigation agent. It works to kill bacteria!
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marfknox
SFN Die Hard

USA
3739 Posts

Posted - 04/07/2008 :  20:02:31   [Permalink]  Show Profile  Visit marfknox's Homepage  Send marfknox an AOL message Send marfknox a Private Message  Reply with Quote
Dave wrote:
I don't see anything particularly woo, either, but I question spending $15 when a large-bore syringe could be had for a couple bucks, tops (even a turkey baster would do the trick).
I could have bought a cheaper pot, too, but I sprung for the larger, stainless steel one. It looks better, feels less clinical that a syringe, is easy to pour warm water from the sink into, and is big enough to do both nostrils at once. I'll pay a few bucks extra for comfort and convenience.

Dude wrote:
Try a nasal steroid (nasonex or flonase). As a person who has idiosyncratic reactions to some common medicines (not allergies), I've never had a problem with this med. It reduces sinus inflammation.

Saline irrigation of sinuses can clear them out, but it does nothing to deal with the underlying problem.
Thank you for the recommendations, however, how do nasal steroids deal with the underlying problem?

bngbuck wrote:
Has your doctor identified the source of your chronic sinus inflammation? If it is allergenic in origin, antihistamines will help. Chronic inflammation which is not infectious should respond to topical steroids as Dude suggests. If there is infection present, antibiotics are in order, but several of the sinus cavities have practically no blood supply so it takes a lengthy regimen of antibiotics to finally penetrate to the infected area!
To answer your questions: The source is currently unknown (although I strongly suspect the huge amounts of time spent with young children), I have no allergies, I cannot take antihistamines without switching from an extremely reliable "no baby pill" to a less preferred form of birth control, and it is doubtful that I have an infection which requires antibiotics given that the problem has subsided for the past couple months.

Given what I've found so far and the comments here, I guess I can just be happy that the neti pot apparently does some good and just keep using it.

"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong

Check out my art store: http://www.marfknox.etsy.com

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JohnOAS
SFN Regular

Australia
800 Posts

Posted - 04/07/2008 :  20:26:16   [Permalink]  Show Profile  Visit JohnOAS's Homepage Send JohnOAS a Private Message  Reply with Quote
I do actually remember, some time ago hearing someone on some podcast whining about the popularity of this process, and discussing the merits thereof. From memory, whoever the guest/interviewee was, they spoke of it being of dubious value.

This however, doesn't reflect my opinion, especially after reading the posts here and looking around a little elsewhere. I only mention it because there's a reasonable chance some other SFN member my have listened to the same podcast.

I'm reasoanably sure it was a female interviewer, and I'm leaning towards Swoopy from Skepticality or Rebecca from Skepchick/SGU. I'm just not sure.

John's just this guy, you know.
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Dude
SFN Die Hard

USA
6891 Posts

Posted - 04/07/2008 :  20:30:17   [Permalink]  Show Profile Send Dude a Private Message  Reply with Quote
marf asked:
Thank you for the recommendations, however, how do nasal steroids deal with the underlying problem?

If you have a chronic sinus inflammation (sinusitis), there are a limited number of causes. Infection and allergies are the usual suspects. You say you don't have allergies, but if you have a chronic sinus problem that isn't an infection (your doctor should be able to make that determination fairly easily), then you probably have an allergy to something.

Something is causing your sinuses to become inflamed, and a nasal corticosteriod can provide local anti-inflamatory action to relieve the symptom. Ask your doctor.


Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson

"god :: the last refuge of a man with no answers and no argument." - G. Carlin

Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth
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bngbuck
SFN Addict

USA
2437 Posts

Posted - 04/07/2008 :  22:46:40   [Permalink]  Show Profile Send bngbuck a Private Message  Reply with Quote
Marf....

If it is, or was, not an infection, how would it's source be related to the small children with whom you are associated for long periods of time?

Edited to bold "not" 4/8/08
Edited by - bngbuck on 04/08/2008 12:22:42
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marfknox
SFN Die Hard

USA
3739 Posts

Posted - 04/08/2008 :  08:33:40   [Permalink]  Show Profile  Visit marfknox's Homepage  Send marfknox an AOL message Send marfknox a Private Message  Reply with Quote
If it is, or was, not an infection, how would it's source be related to the small children with whom you are associated for long periods of time?
You don't think it is easier to get an infection while spending hours and hours around little children who are sick and have runny noses and who sneeze in your face and forget to wash their hands?

I really don't know if it was an infection. All I know is that ever since I started teaching, I have colds, headaches, and bouts of terrific nausea. If the biggest culprit was sinus infection, it certainly doesn't seem to be a problem now, so apparently my body managed to fight it off. And frankly, I'm glad I didn't listen to the doctor who told me to take Claritin. I've taken Claritin before; it makes me feel crappy - all medicine headish and such. All the migraine meds the docs gave me either did nothing or made me even more sick, too. (That's how my doc started thinking it wasn't migraines, but sinus disease. But to be honest, I'm still not convinced that's even the problem either.) I get why people turn to alternative medicine; when the root of the health problem is foggy, it's like flinging darts at a bullseye. Not that most alternative meds do anything other than placebo and shrink one's wallet.

"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong

Check out my art store: http://www.marfknox.etsy.com

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Kil
Evil Skeptic

USA
13462 Posts

Posted - 04/08/2008 :  09:17:07   [Permalink]  Show Profile  Visit Kil's Homepage  Send Kil an AOL message  Send Kil a Yahoo! Message Send Kil a Private Message  Reply with Quote
Yeah, but Dude is right about the anti inflammatory effectiveness of nasal steroids. And a puff up the nose before bedtime is probably a lot less of a hassle than the method you are using. As for the cause, how do you know the saline solution you are using to drain with is treating the cause? If it were, you should be able to stop the procedure by now without any return of the symptoms.

On the other hand, as with all meds, there can be some issues with regular steroid use. But in my experience of using nasal products like flonase, I have nothing negative to report. So for me, it would come down to which method is more convenient if both of them worked.

I am rather surprised that your doc did not try something like flonase out on you.

I also get migraines, and have since I was an adolescent. Lucky for me they have decreased in severity over the years, because just about every migraine specific med, to this day, has made me feel awful, including Imitrex. It has gotten so I can now get by on a pharmaceutical dose of ibuprofen to control the pain...

Uncertainty may make you uncomfortable. Certainty makes you ridiculous.

Why not question something for a change?

Genetic Literacy Project
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Dude
SFN Die Hard

USA
6891 Posts

Posted - 04/08/2008 :  11:27:07   [Permalink]  Show Profile Send Dude a Private Message  Reply with Quote
marfknox said:
(That's how my doc started thinking it wasn't migraines, but sinus disease. But to be honest, I'm still not convinced that's even the problem either.) I get why people turn to alternative medicine; when the root of the health problem is foggy, it's like flinging darts at a bullseye.

So you don't believe the MRI results?

The answer is simple, take the MRI and go get a second opinion. Talk to an ENT specialist if you haven't yet.


Kil said:
On the other hand, as with all meds, there can be some issues with regular steroid use.

Nasal steroid sprays provide local action. You don't have the same issues as if you were taking corticosteroid pills or injections.


Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson

"god :: the last refuge of a man with no answers and no argument." - G. Carlin

Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth
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marfknox
SFN Die Hard

USA
3739 Posts

Posted - 04/08/2008 :  11:55:26   [Permalink]  Show Profile  Visit marfknox's Homepage  Send marfknox an AOL message Send marfknox a Private Message  Reply with Quote
Kil wrote:
Yeah, but Dude is right about the anti inflammatory effectiveness of nasal steroids.
I agree.

And a puff up the nose before bedtime is probably a lot less of a hassle than the method you are using.
I kind of like pouring warm water through my sinuses. It feels weird in a nifty kind of way.

As for the cause, how do you know the saline solution you are using to drain with is treating the cause?
Whoa, whoa, whoa when did I ever claim that it was treating the cause? The only thing I've suggested as one possible cause of my sinus problems is being around sick little kids all the time. But mostly I just say I don't know why my sinuses get easily blocked and inflamed. All I suspect the neti pot is doing is clearing my sinuses. It's like my plantar faciitus: one doctor thinks it is caused by high arches, another by a biking accident I had a few years ago, another by bone spurs. I really don't care which of those is the cause since I can't do anything about it. I need the pain managed, and I need it managed without causing me whole new problems. I mean, if the cause is something which is fixable, obviously that is preferred.

But in my experience of using nasal products like flonase, I have nothing negative to report. So for me, it would come down to which method is more convenient if both of them worked.
Yeah, everyone is different. Will got an irritated throat from flonase and was happy to stop using it, although he admitted it worked to help with is allergies. One of the side effects is nausea. That is the one I am most prone to, so unless I am in really bad shape and have no other resource, I will avoid things which might make me nauseous.

I am rather surprised that your doc did not try something like flonase out on you.
Given what Dude has said, so am I!

I also get migraines, and have since I was an adolescent. Lucky for me they have decreased in severity over the years, because just about every migraine specific med, to this day, has made me feel awful, including Imitrex. It has gotten so I can now get by on a pharmaceutical dose of ibuprofen to control the pain...
That's pretty awesome. Lately mine have gone back to the way they were before all this teaching, which is that I mostly just get mild ones triggered by certain types of light. Then again, sensitivity to light is also a symptom of sinus problems and a bunch of other things. So again I got back to the problem that all of the problem is probably yet undiagnosed.

Dude wrote:
So you don't believe the MRI results?
Of course I believe the MRI results which showed that I had inflamed sinuses. I also was scheduled to get the MRI while still sick in between a nasty cold and a respiratory infection. Is sinus disease the reason I've had many other symptoms, such as paralysis, dizziness, sensitivity to light and noise, and powerful nausea that lasts from hours to days? Maybe. Certainly possible. But to say that is the conclusive explanation would be premature given the current data.

The answer is simple, take the MRI and go get a second opinion. Talk to an ENT specialist if you haven't yet.
Actually, the next step if the sinus problem comes back is to get a CAT scan to get a better look. This poses whole new problems because they can't inject me with the dye for other medical reasons, so they won't be able to get a good enough look. Keep in mind that this particular problem (the headaches which seemed to have been caused by sinus inflammation) has subsided, but if it returns I will be very open to these other avenues presented here.

Nasal steroid sprays provide local action. You don't have the same issues as if you were taking corticosteroid pills or injections.
I don't know about that. To be effective they must be taken daily and eventually over longterm they can cause metaplasia. http://en.wikipedia.org/wiki/Metaplasia

"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong

Check out my art store: http://www.marfknox.etsy.com

Edited by - marfknox on 04/08/2008 11:56:34
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bngbuck
SFN Addict

USA
2437 Posts

Posted - 04/08/2008 :  12:16:50   [Permalink]  Show Profile Send bngbuck a Private Message  Reply with Quote
You don't think it is easier to get an infection while spending hours and hours around little children who are sick and have runny noses and who sneeze in your face and forget to wash their hands?
No, Marf, you said:
The source is currently unknown (although I strongly suspect the huge amounts of time spent with young children),
and:
and it is doubtful that I have an infection which requires antibiotics given that the problem has subsided for the past couple months.
I just have trouble reconciling these two statements. Infections come and go. For two months you have not had an infection. Were you with children during that time? If so, perhaps for two months none of the children in your care happened to have colds.

My point is, can you pinpoint having a sinus infection with your daily association with children? If so, then you have solved half of your problem. the source. Wear a mask, wash your hands frequently and have them wash theirs to the best of your ability, identify the children with colds and call their parents and tell them to keep the kids home for a while until they get over their 7 day ailment.

If you have chronic sinus infection - which does not sound likely in that you have had no symptoms for two months - you need to consult a Ear Eye Nose and Throat specialist (more likely today, just ENT), for antibiotic irrigation. If your infection is in the accessible sinus cavities and it goes away when you have not been in contact with children with colds, what can I say? It seems obvious.
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Dude
SFN Die Hard

USA
6891 Posts

Posted - 04/08/2008 :  12:38:16   [Permalink]  Show Profile Send Dude a Private Message  Reply with Quote
http://www.spfiles.com/pinasonex.pdf
Carcinogenesis, Mutagenesis, Impairment of Fertility: In a 2-year carcinogenicity
study in Sprague Dawley rats, mometasone furoate demonstrated
no statistically significant increase in the incidence of tumors at inhalation
doses up to 67 mcg/kg (approximately 1 and 2 times the maximum recommended
daily intranasal dose [MRDID] in adults [400 mcg] and children [100
mcg], respectively, on a mcg/m2 basis). In a 19-month carcinogenicity study
in Swiss CD-1 mice, mometasone furoate demonstrated no statistically significant
increase in the incidence of tumors at inhalation doses up to 160
mcg/kg (approximately 2 times the MRDID in adults and children, respectively,
on a mcg/m2 basis).
Mometasone furoate increased chromosomal aberrations in an in vitro
Chinese hamster ovary-cell assay, but did not increase chromosomal aberrations
in an in vitro Chinese hamster lung cell assay. Mometasone furoate was
not mutagenic in the Ames test or mouse-lymphoma assay, and was not clastogenic
in an in vivo mouse micronucleus assay and a rat bone marrow chromosomal
aberration assay or a mouse male germ-cell chromosomal aberration
assay. Mometasone furoate also did not induce unscheduled DNA synthesis
in vivo in rat hepatocytes.
In reproductive studies in rats, impairment of fertility was not produced by
subcutaneous doses up to 15 mcg/kg (less than the MRDID in adults on a
mcg/m2 basis).


(hit "post" instead of "preview"... so editied to add:)
Metaplasia isn't indicitave of a disease, a chronic sinusitis could cause metaplastic changes in your nasal mucosa too. And I see no indication of this as a side effect of topical steriods after reading through the product labels of several.


Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson

"god :: the last refuge of a man with no answers and no argument." - G. Carlin

Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth
Edited by - Dude on 04/08/2008 12:43:51
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marfknox
SFN Die Hard

USA
3739 Posts

Posted - 04/08/2008 :  17:47:43   [Permalink]  Show Profile  Visit marfknox's Homepage  Send marfknox an AOL message Send marfknox a Private Message  Reply with Quote
bngbuck wrote:
I just have trouble reconciling these two statements. Infections come and go. For two months you have not had an infection. Were you with children during that time? If so, perhaps for two months none of the children in your care happened to have colds.
I'm sorry if I haven't explained this all in enough detail to make it clear what my current assumptions and interpretations of my own symptoms are. I taught a few years ago in Korea. Previous to that, I have hardly ever gotten sick with sinus problems, save for the occasional mild cold. But that year (that I taught kindergarten) I was sick, mostly with sinus and throat problems, 8 months out of the year. So obviously I was not sick 4 months of that year, however, those 4 months of wellness do not stop me from being convinced that being around drippy, sneezey, sicky children was at least partially to blame for my 8 months of illness. I did not teach little kids for 4 years after that, and reverted back to my normal hardly-ever-sick mode. But when I started teaching the Fall of 2006, I immediately started to get just as sick as I did in Korea, and just as often. Now this second year hasn't been as bad, and I guess that's just my immune system adjusting. This all said, there are many possibilities given my set of symptoms and potential environmental or internal causes. Here's just a few:

-All of my symptoms are caused by migraines, which have either become worse with age or are triggered worse by something that comes and goes in my current work environment, and the sinus inflammation was just a coincidence
-All of my symptoms are caused by sinus disease, which is either caused by something unknown in my environment or by newly developed allergies.
-All of my symptoms are caused by anxiety or other mental disorder, yet undiagnosed.
-My symptoms are caused by some mix (2 or more) of migraines, anxiety or other mental disorder, and sinus disease, with cause of sinus disease unknown

Figuring out this puzzle in its entirety would be quite a laborious, expensive, and occasionally painful task, even for modern medicine and its marvels. It would involve treatment for the anxiety disorder I know I have which prevents me from behaving rationally around needles. From there I could then go on to get a CAT scan and allergy tests. But even then only some things could be ruled out or probably in.

I really wish I just had a broken arm.

My point is, can you pinpoint having a sinus infection with your daily association with children?
No. If I felt I could pinpoint it I wouldn't have brought it up with such uncertainty.

Wear a mask, wash your hands frequently and have them wash theirs to the best of your ability, identify the children with colds and call their parents and tell them to keep the kids home for a while until they get over their 7 day ailment.
LOL! Wait, you were serious, weren't you? I did start washing my hands obsessively this year, so that might partially explain why I've been sick less than last year. But Bill, PreK and kindergarten kids have runny noses constantly. How am I supposed to know for sure if they are sick or not? Do you honestly think that if I call parents requesting this that they will comply? And wear a mask? I'm sorry, but I am not doing that.

If you have chronic sinus infection - which does not sound likely in that you have had no symptoms for two months - you need to consult a Ear Eye Nose and Throat specialist (more likely today, just ENT), for antibiotic irrigation.
If I get sick again and it persists, I will ask my doctor about this.

Dude wrote:
Metaplasia isn't indicitave of a disease, a chronic sinusitis could cause metaplastic changes in your nasal mucosa too. And I see no indication of this as a side effect of topical steriods after reading through the product labels of several.
I will definitely try nasal steroids if the problem comes up again and persists. In the meantime, I'll keep using the neti pot, drinking lots of peppermint tea, and be thankful that I'll no longer be teaching full time come mid-June.

Oh, and Dude, quit being lazy and write in your blog.

"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong

Check out my art store: http://www.marfknox.etsy.com

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