Antihistamines vs sinus pain (sinuses, allergy, back pain, restless leg syndrome)

[ElSol]

I have severe seasonal allergies, mostly due to pollen from grasses (had severe reaction to grasses in allergen test, some but much less severe reaction to dust mites, trees).

I take Zyrtec nightly during allergy season, and have on&off taken Singulair in addition. I also use Flonase during allergy season, though I'm not convinced it does anything for me. Zyrtec, it seems, 95% addresses the typical allergy symptoms- sneezing, itchy red eyes, running nose, itchy skin, etc. During the height of allergy season some of that starts to break through, but this is infrequent.

While blocking these allergy symptoms, Zyrtec, Singulair and other anti-histamines seem to have little or no affect on my cycle of sinus pain. I'm trying to understand that, to learn what I may do to manage this better. I'm 55 and have grappled with this my whole life, but its just unbearable and I'm not sure this is survivable when I get into my older years.

During allergy season I have headaches, often debilitating, from acute sinus pain. I tend to have this sinus pain even when I'm breathing freely through my nose. In fact, often breathing through my nose increases the pain until my nasal passages inflame and finally block the air flow. Unmanaged, the irritated sinuses inevitably lead to sinusitis causing a post-nasal drip that gives me a constant hacking cough. This cough will keep me awake at night, causing sleep depravation and an escalating cycle. This leads to sinus and ear infection that require medical intervention (and some debates with Drs whether or not its bacterial and needs antibiotics). Fortunately, I have learned to stop this before it escalates and it has been a few years since I've needed to seek medical attention for this. This same cycle is also triggered whenever I get a common cold, but again I can now manage it.

Once the sinus pain reaches a certain level, it becomes impervious to treatment with ibuprofen or other OTC analgesics (well, it's more complicated than that-- my circadian/metabolic cycles somehow factor into this). At best, Advil will take the edge off. This pain drains my energy and makes it hard to be productive and lead a normal life.

I get these same "sinus headaches" year round- but it's a daily struggle during allergy season. Occasionally when this headache is especially bad, I'll get intense pain in my neck/upper spinal column, in the back of my head. No doctor has really given me a good explanation for this. I know my sinuses aren't back there, but this pain is 100% associated with sinus pain developing first. When this pain develops, it will typically take 2.5 go 3 days for the pain to go away. This is like a migraine, from the impact it has on me. But this close correlation with sinus pain has led me to believe this isn't a typical migraine or stress headache. I've also had, a handful of times in my life (not many) headaches which more closely match what people describe as migraines. When under a lot of work pressure I'll occasionally get stress headaches. So, I've come to recognize this persistent headache that I've had my whole life is related to the same inflammation cycle driving my sinus headaches- though I haven't had a doctor agree with me on that. The good news is this highest level of headache seems to have self-resolved in the last several years. I suspect that this is related to my circadian/metabolic cycle, which changed when I hit my 50s (I'm something of a workaholic, but not nearly as intense as my younger years).

Lately, I've noticed a few things:
- When my sinus issues start escalating to the post-nasal drip stage, I've learned that taking sudafed (the real stuff) + mucinex + advil before bed opens everything up, I sleep like a baby, and I return to "just" having sinus pain. 2-3 nights and the congestion/cough are gone, with no doctor visit.
- Recently, I decided to use this remedy as soon as I felt the first signs of nasal blockage, not waiting for the cough. This not only stopped it from escalating, but 100% eliminated my sinus pain for several days. I was delighted that I may have finally found a full remedy, but i consulted my Dr about it and he said I can't take Sudafed regularly.
- To the point on Sudafed above, it does noticeably elevate my already marginally high blood pressure. It also (and this is something new) causes my prostate to enlarge, reducing urination flow substantially. This is something I need to follow up on in the near future, but clearly I can't take Sudafed regularly. (normal urination returns when I stop the sudafed)
- Instead, I've used Flonase regularly and have started regularly using a nasal rinse (nightly) and saline spray (frequently through the day).
- This seems to be *helping* manage my daily sinus pain, but I still end up with days where I can barely function.

I stay mostly indoors. Have HEPA filters in my AC. Don't have mold that I'm aware of (and I get these problems regardless of where I live). I don't go to extremes with vacuuming and other things for dust mites- as noted my strongest reaction is to grass. But I can't rule out that the baseline issue is other common allergens. We have pets, but these problems existed through my life both with and without pets.

I don't have food allergies in general. I have some data points that suggest a possible link, though, to gluten allergy, sugar in general, dietary histamines, and malt. Nothing I can say for sure. As for gluten, I don't think I'm celiac (I don't have enough of the symptoms). But when I went on a very low carb diet once it seemed to stop the sinus headaches for a while. But if there's a connection, it's just too loose to nail down. A more reliable indication is red wine- I get the "red wine headache" when I have more than 2 glasses of red wine, and it is this same kind of headache described above. I've seen research on this- some people suspect tannins, but my suspicion is this is due to dietary histamine. I also occasionally get instant headaches from even one beer, but not always. I'm coming to suspect this is from malted beer- and one time in my life I had a severe allergic reaction when I drank a malted milkshake (haven't had one since so I don't know if this is a real allergy). I've stopped drinking red wine (sad because I love it) and only seldomly drink beer.

I guess this is pretty long, but I'm looking for advice from anyone else on figuring out how to address this, or live with it.

[RamenAddict]

Unfortunately while Sudafed works, it has side effects that make it impractical for many people to use regularly. I tend to have a variety of problems, including restless leg syndrome, that make sleeping difficult.

I have started to use Xlear spray, which is saline with xylitol. It is helpful for me and I can use it regularly before sleep. There is also a “max” type for use when you have severe congestion.

That said, you may want to see a neurologist for migraine. Apparently there is a strong link between the two. I do get both and my symptoms are often similar to yours. I had a bad migraine about a week ago and it was triggered when I was outside exercising in cold weather- that tends to irritate my sinuses. My best friend has tried allergy shots with no real luck and also gets migraines. The neck/back pain is a symptom of the migraine as well. FWIW, I take Flonase, Allegra (pm), Zyrtec (am) and also have olopatadine nasal spray and eye drops to use as needed. I tend to use the Xlear spray daily (mostly the regular) at least at night. The olopatadine helps more with the postnasal drip and is prescription only.

I take a beta blocker for migraine. One thing to be careful of with the Advil is that you need to make sure you aren’t using it too often. If you do, then you can get rebound headaches. I know I’ve had that before and now generally keep it to no more than 3 days a week. I am female, so at some points during my cycle I have to use more because the migraines can really be persistent. I do have headaches that feel like instant sinus headaches. Those seem to resolve pretty quickly if I take Excedrin/BC powder (which is aspirin/caffeine) as soon as it comes on.

FWIW, I actually had some migraine treatment through an allergist associated with a medical school, so I think the link is pretty well know/common.

[AZgarden]

I realized, after many many seasons of working in the garden, walking the dog, and being outside, that I need to wear a mask during allergy season, which to me is mostly Fall and Spring. I have tried so many sprays, washes, pills, etc., but the mask, now even fashionable in this covid time, is what I need to do. Also the Neti pot or XClear is very helpful for me. I also have migraines, but mine are cervical migraines, affecting just my eye with wavy lines for about 15 minutes, but no pain. I did suffer real migraines when younger and Imitrex was my saviour at that time. A shot in the thigh made it go away instantly. Wish I had something like that for sinus pain.

[fluffythewondercat]

I'm back to using Allegra D this season, because the Azelastine nasal spray prescribed for me only works about 1/3rd of the time, if that.

Last week my allergist's PA scolded me for using Allegra D, saying the pseudoephedrine elevates blood pressure and heart rate. So I tested it. Two hours after taking an Allegra D 12 hour capsule, my BP was 120/67, heart rate 70. I'll keep using it as necessary.

[adventuregurl]

In the past the only thing that helped my sinuses was Sudafed. You could try it and see. I'm not sure if you can take Zyrtek with it though but check with the pharmacist.

I have bad sinus pain which I think is due to pressure and I don't have a runny nose or mucous - everything is very dry which probably contributes to the problem.

I just bought a product yesterday at the health food store here called "Allergy Mix" it's homeopathic so you can take it with your other meds and the one I purchased is designed for the local allergies (Phoenix, Mesa, Scottsdale etc.) and I am AMAZED by how good it made me feel - I felt awful (I felt full blown sick to the point where I was in bed for part of the day) before it and the Flonase and Sudafed I took didn't help much. You can take this one 6 times a day and I LOVE it. They make it for other areas https://allergymix.com/.

The gal at the store told me the nasal spray works the fastest and it was amazing for me!