During the past 15 years, I have been getting what I believe are sinus headaches. They start with a slight pain above my eye. My eye gets extremely red and then the pain extends down the side of my face to the neck. After several pain relievers and several snorts of a nasal spray, the pain goes away as fast as it came on. The entire process lasts about 45 minutes and can occur several times a day. Sometimes it has subsided for as long as a year or two. I have been to my family physician, had CAT scans, etc. Any suggestions?

T.B.

Have you really been putting up with this for 15 years, without consulting a specialist? Generalists cannot know everything about everything. Specialists exist for a reason. When your family physician cannot help you, it's time to see a specialist.

But what kind of specialist? If you are having "sinus headaches," perhaps you need to see an ear, nose and throat specialist (ENT). But I don't think that's what you are having. Even though the pain originates over your eye (an area that corresponds to the frontal sinus), you may not be having sinusitis. In fact, the rapid resolution of your symptoms with pain medications and nasal sprays argues against sinusitis. True sinus headaches tend to be more stubborn than this.

What about the red eye -- does this mean you need to see an eye specialist (ophthalmologist)? Acute iritis (uveitis) can cause a red eye and headache, but it tends to last days, not 45 minutes. Conjunctivitis, similarly, would not be so brief. Nevertheless, these are possibilities, and consultation with an ophthalmologist would certainly not be a mistake.

But I'm betting that you need to see a neurologist. Neurologists are the true masters of the headache -- though some of my ENT colleagues feel that we deserve this title! The description of your symptoms is most reminiscent of "cluster headache," a condition most appropriately diagnosed and treated by a neurologist. Here's the classical description of a cluster headache. The cluster headache suffer is usually a male whose headaches start between the ages of 20 to 50. The headaches are one-sided, extremely severe, and last from 30 to 120 minutes. There is no aura, as in migraine. (An aura is a sensory disturbance, such as seeing flashing lights or wavy lines, before the onset of headache.) There is no nausea or vomiting. The nasal passage on the involved side may become congested or may "run." The eye becomes red and may tear excessively. The sufferer is very restless and typically paces the house until the headache passes. They're called "cluster" headaches for a reason. They occur on a regular basis (most often at night) for one to four months, and then vanish for a year or two -- only to be followed by another cluster.

If my hunch is correct, then I have some good news for you: Cluster headaches are treatable. The bad news is that you have suffered from this, unnecessarily, for 15 years! The moral of this story is that generalists must refer patients to specialists when they are stumped, and patients must DEMAND referral when they receive the "I'm sorry, but you'll just have to live with it" speech from their family doctor.