Facial Pressure Often Means Migraine, Not Sinusitis

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Struggling to differentiate sinus symptoms? You're not alone—medical training often falls short.

In this solo episode of Succeed in Medicine, Dr. Bradley Block shares how to distinguish between colds, bacterial sinusitis, allergies, and sinus migraines. With insights from years of clinical experience, on sinusitis as a secondary bacterial infection following viruses, not allergies or blockages. He covers "second sickness" patterns, why 10-day watchful waiting beats early antibiotics, migraine misdiagnoses, and treatments like nasal steroids for allergies versus surgery for fungal balls. Debunking myths like balloon sinuplasty for migraines. 

This episode equips physicians with practical tools to avoid overtreatment and improve patient outcomes, learn why facial pressure often points to migraines, when antibiotics are truly needed, and how to spot the “second sickness” pattern of sinus infections. Packed with practical tips and myth-busting, this episode is a must-listen 

for anyone navigating sinus issues or curious about ENT care.

Three Actionable Takeaway:

• Sinusitis Starts with a Virus: Dr. Block explains bacterial sinusitis as a secondary infection after a cold disrupts sinus mucosa—watch for "second sickness" where symptoms worsen after initial improvement. Hold antibiotics for at least 10 days unless complications like orbital cellulitis arise.
• Facial Pressure Isn't Always Sinus: Often misdiagnosed as sinusitis, facial pressure (especially weather-related) signals migraines—Dr. Block advises checking for tenderness over sinuses and avoiding unnecessary CT scans or surgery like balloon sinuplasty, which treats mucosa issues poorly.
• Allergies vs. Sinusitis: Separate Issues: Allergies swell nasal mucosa but don't cause sinus infections due to insufficient allergen entry—treat with nasal steroids or immunotherapy. Fungal balls require surgery, not meds, as they're not true infections.

About the Show:

Succeed In Medicine  covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!

About the Host:

Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physicians

Want to be a guest?

Email Brad at brad@physiciansguidetodoctoring.com  or visit www.physiciansguidetodoctoring.com to learn more!

Socials:

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@physiciansguide on Instagram and Twitter

This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!

Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let’s grow! 

Disclaimer:

This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance.

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