Sinus headache Information | Mount Sinai

Headache – sinus

Signs and Symptoms

Sinus headaches typically have the following symptoms:

• Pressure-like pain in one specific area of your face or head (for example, behind your eyes)
• Face is tender to the touch
• Pain is worse with sudden movements of the head and bending forward
• Pain is worse in the morning because mucus collects and drains through the night
• Sudden temperature changes, like going out into the cold from a warm room, worsen the pain
• Headache often starts when you have a bad cold or just after
• Congested or runny nose

Other symptoms may be related to sinus inflammation (sinusitis):

• Fever
• Postnasal drip with sore throat (pharyngitis)
• Yellow or green discharge from your nose
• Red and swollen nasal passages (nasal congestion)
• Mild-to-moderate fever
• A sense of not feeling well
• Fatigue
• Pain in upper teeth

Migraines may feel worse when you bend forward and can be accompanied by nasal congestion. But a migraine is more likely to be made worse by noise or light, and to be accompanied by nausea.

Causes

Sinus headaches can be caused by sinus congestion and inflammation, called sinusitis. Sinusitis, in turn, is caused by either a respiratory infection, such as a cold or flu, or allergies, like hay fever.

Healthy sinuses allow mucus to drain and air to circulate throughout the nasal passages. When sinuses become inflamed, these areas get blocked and mucus cannot drain. When sinuses are blocked, they provide a place for bacteria, viruses, and fungus to live and grow rapidly. Although a cold is the most common culprit, sinusitis can be caused by anything that prevents the sinuses from draining.

Risk Factors

• History of allergies, especially hay fever, or asthma
• Nasal polyps or swellings in the nasal passage, nasal bone spurs, nasal or facial tumor, deviated septum, or cleft palate
• Climbing or flying to high altitudes
• Frequent swimming or diving

Diagnosis

Your doctor will ask questions to distinguish sinus headaches from migraines or tension headaches. If you have had a recent cold, allergy flare up, or symptoms of sinusitis, it will help your doctor make a diagnosis.

Your doctor will look in your nose to check for congestion and nasal discharge. Your doctor will also press on areas of your face to check for tenderness. Your doctor may shine a light through the sinuses to look for sinus inflammation; if the light does not shine through, your sinuses may be congested.

If your doctor suspects chronic sinusitis, you may need imaging tests, including an x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI). If your doctor suspects allergies may be causing your sinusitis, you may need an allergy test. Your doctor may also refer you to a specialist, known as an ear, nose and throat (ENT) doctor, or an otolaryngologist. This specialist may perform a nasal endoscopy using a fiber optic scope to look at your sinuses.

Treatment Approach

The best way to avoid or get rid of a sinus headache is to treat the underlying sinus inflammation. Sinus pain caused by allergies may be helped by allergy medications and medicated nasal sprays. Your doctor may prescribe antibiotics or corticosteroids. Lifestyle changes, such as using a humidifier or irrigating your nasal passages with salt water, may also help. Several dietary supplements and herbs may help prevent colds and flu, shorten their duration, or work together with antibiotics to treat your infection and support your immune system. Flushing the nose and sinuses with saline solution may also help.

Lifestyle

Doing the following things can help reduce congestion in your sinuses:

• Using a humidifier
• Using a saline nasal spray
• Breathing in steam 2 to 4 times per day (for example, sitting in the bathroom with the shower running)
• Quickly treating allergic and asthma attacks

Other techniques that might help include:

• Stretches for the head and neck
• Relaxation techniques (see Mind-Body Medicine section)

Medications

Antibiotics. Your doctor may prescribe antibiotics if they suspects you have a bacterial infection. To treat acute sinusitis, you may take from 10 to 14 days of antibiotics. Treating chronic sinusitis may take longer, usually 3 to 4 weeks.

Nasal corticosteroids. These prescription sprays reduce inflammation of the nose and help relieve sneezing, itching, and runny nose. They are most effective at reducing symptoms, although it can take anywhere from a few days to a week after you start using them to see improvement.

• Beclomethasone (Beconase)
• Fluticasone (Flonase)
• Mometasone (Nasonex)
• Triamcinolone (Nasacort)

Antihistamines. Antihistamines are available in both oral and nasal spray forms, and as prescription drugs and over-the-counter remedies, to treat allergies. Over-the-counter antihistamines are short acting and can relieve mild-to-moderate symptoms. All work by blocking the release of histamine in your body.

• Over-the-counter antihistamines: Include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), and clemastine (Tavist). These older antihistamines can cause sleepiness. Fexofenadine (Allegra), cetinzine (Zyrtec), and loratadine (Claritin) are newer antihistamines that do not cause as much drowsiness.

Decongestants. Many over-the-counter and prescription decongestants are available in tablet or nasal spray form. They are often used in combination with antihistamines.

• Oral and nasal decongestants: Include Sudafed, Actifed, Afrin, and Neo-Synephrine. Some decongestants may contain pseudoephedrine, which can raise blood pressure. People with high blood pressure or enlarged prostate should not take drugs containing pseudoephedrine. Avoid using nasal decongestants for more than 3 days in a row, unless specifically instructed by your doctor, because they can cause rebound congestion. Do not use them if you have emphysema or chronic bronchitis.

Triptans. In one study, 82% of people with sinus headaches had a significant response to triptans, a medication commonly used for migraines.

Surgery and Other Procedures

For chronic sinusitis that does not respond to medication, your doctor may recommend endoscopic sinus surgery, which may be done to remove polyps or bone spurs. Some doctors also recommend enlarging the sinus opening. A newer procedure called balloon rhinoplasty involves inserting a balloon inside the sinus cavity and then inflating it.

Sinus surgeries are done by an ENT specialist.

Nutrition and Dietary Supplements

Several supplements may help prevent or treat sinus headaches, either by reducing sinus inflammation, or by helping to ward off colds. (See Sinusitis for more details.) Because supplements may have side effects, or interact with medications, you should take them only under the supervision of a knowledgeable health care provider.

• Bromelain. Several studies suggest that bromelain, an enzyme derived from pineapples, may help reduce inflammation and swelling and relieve symptoms of sinusitis. However, not all studies agree. Bromelain is often combined with quercetin, a flavonoid or plant pigment responsible for the colors found in fruits and vegetables, which may act as an antihistamine. Bromelain may increase the risk of bleeding, so people who take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix) should not take bromelain without talking to their doctor first. Taking bromelain with ACE inhibitors may cause a drop in blood pressure, called hypotension. Bromelain may interact with certain antibiotics as well. Speak with your doctor.
• Quercetin. In test tubes, quercetin stops the production and release of histamine, which causes allergy symptoms, such as a runny nose and watery eyes. It is often combined with bromelain. However, there is not yet much evidence that quercetin would work the same way in humans. More studies are needed. Some people may prefer water-soluble forms of quercetin, such as hesperidin methyl chalcone (HMC) or quercetin chalcone. Quercetin may interact with certain medications, so ask your doctor before taking it.
• Probiotics (Lactobacillus). Probiotics, or “friendly” bacteria, may help if you are taking antibiotics for sinusitis. They may also reduce your chances of developing allergies. People who have very weakened immune systems or who take drugs to suppress the immune system should ask their doctor before taking probiotics.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.

As with supplements, there are many herbs that may help reduce your chances of getting a sinus headache by preventing or treating a cold, boosting your immune system, or reducing sinus inflammation.

Sinupret, a proprietary formulation containing European elder (Sambucus nigra), common sorrel (Rumex acetosa), cowslip (Primula veris), European vervain (Verbena officinalis), and gentian (Gentiana lutea). In two studies, Sinupret was found to work better than placebo in relieving symptoms of sinusitis. The herbs it contains may work by thinning mucus and helping the sinuses drain, and they may also help strengthen the immune system.

Although research is lacking, other herbs have been used traditionally to treat headaches:

• Chinese skullcap (Scutellaria baicalensis)
• Feverfew (Tanacetum parthenium)
• Willow bark (Salix spp.)

People who take blood thinners, or women who are pregnant or breastfeeding, should not take these herbs. People who are allergic to aspirin should not take willow bark. Feverfew can interact with several medications. If you are allergic to ragweed you may also be allergic to feverfew.

Homeopathy

One of the most common reasons people seek homeopathic care is to relieve chronic headaches. Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for sinus headaches based on their knowledge and clinical experience. In one study of homeopathy for sinusitis, more than 80% of the participants had significant improvement in their symptoms after taking the homeopathic remedy for 2 weeks.

Before prescribing a remedy, homeopaths take into account a person’s constitutional type. In homeopathic terms, a person’s constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are remedies commonly prescribed for sinus congestion and headache:

• Arsenicum album. For throbbing, burning sinus pain that is relieved by lying upright in a cool room with open windows.
• Belladonna. For throbbing headaches that come on suddenly and feel worse with motion and light; pain is partially relieved by pressure, standing, sitting, or leaning backwards.
• Bryonia. For headaches with a steady, sharp pain that occurs most often in the forehead but may radiate to the back of the head; symptoms tend to worsen with movement and light touch, but firm pressure alleviates the pain; the person for whom this remedy is most appropriate is usually irritable and may experience nausea, vomiting, and constipation.
• Hepar sulphuricum. For headaches described as “a nail being driven between the eyes,” these types of headaches are often accompanied by thick, yellow nasal discharge; symptoms tend to worsen with movement and light touch of the scalp and improve with pressure.
• Iris versicolor. For throbbing headaches that occur on one side of the head, especially after eating sweets; visual disturbances may also occur; these headaches are worse in the early morning, during spring and fall, and symptoms tend to worsen with vomiting.
• Kali bichromicum. For sinus headaches and congestion; pain often occurs between and behind the eyes; symptoms typically progress throughout the morning, worsen with cold and motion, and improve with warmth and pressure.
• Mercurius. For raw, swollen nostrils; this remedy is most appropriate for individuals whose pain feels as though the head has been placed in a vise; pain may also extend to the teeth; symptoms tend to worsen at night and the individual may alternate between sweating and having the chills; nasal discharge may be bloody.
• Natrum muriaticum. For headaches and congestion associated with allergies.
• Pulsatilla. For headaches triggered by eating rich, fatty foods, particularly ice cream; pain may move around the head but tends to be concentrated in the forehead or on one side of the head and may be accompanied by digestive problems or occur around the time of menstruation; symptoms tend to worsen at night and with coughing and blowing the nose; children often develop these symptoms while at school.
• Silicea. For sinus pain that improves with pressure, head wraps, and warm compresses.
• Spigelia. For stinging, burning, or throbbing sinus pain that often occurs on the left side of the head; symptoms tend to worsen with cold weather and motion but may be temporarily relieved by cold compresses and lying on the right side with the head propped up.

Acupuncture

Although studies are few and have found conflicting results, some people may find that acupuncture helps relieve symptoms of sinusitis. An acupuncturist diagnosis headaches not as migraine, tension, or sinus, but rather as conditions deriving from “energetic” imbalances. Acupuncturists usually describe sinusitis as “dampness” which creates inflammation and congestion in the mucus membranes. This dampness is cleared by strengthening the spleen meridian and by working with the stomach meridian. Practitioners often perform needling therapy and/or moxibustion, a technique in which the herb mugwort is burned over specific acupuncture points, for this condition.

Chiropractic

Although there are no studies on using chiropractic to treat sinus headaches, some practitioners suggest that it may decrease pain and improve sinus drainage for some people.

Mind-Body Medicine

For headaches in general, relaxation techniques can be helpful. This is especially true for frequent headaches, such as sinus headaches. You may want to try these techniques:

• Biofeedback to control muscle tension
• Learn to meditate, breathe deeply, or try other relaxation exercises, such as yoga or hypnotherapy
• Try guided imagery techniques

Other Considerations

If you are not better in a few weeks, your primary care physician may send you to see an ear, nose, and throat specialist for tests to find the cause of your sinus congestion.

Pregnancy

Sinus congestion often acts up during pregnancy. There are many herbs and medications that pregnant and breastfeeding women should not use. Check with your doctor before using any herbs or supplements if you are pregnant or breastfeeding.

Warnings and Precautions

You should go to the emergency room or call 911 if you experience the following:

• Sudden and severe headache that persists or increases in intensity over 24 hours
• A sudden, severe headache that you describe as “your worst ever,” even if you are prone to headaches
• Chronic or severe headaches that begin after age 50
• Headaches accompanied by memory loss, confusion, loss of balance, change in speech or vision, or loss of strength in, or numbness or tingling, in any one of your limbs
• Headaches accompanied by fever, stiff neck, nausea, and vomiting (may indicate meningitis)
• Severe headache in one eye accompanied by redness of the eye (may indicate acute glaucoma)

Supporting Research

Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and adolescence. Pediatr Clin North Am. 2000;47(3):617-31.

Aring AM, Chan MM. Acute rhinosinusitis in adults. Am Fam Physician. 2011 May 1;83(9):1057-63.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:240-3.

Cady RK, Schreiber CP. Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology. 2002;58(9 Suppl 6):S10-S14.

Foroughipour M, Sharifian SM, Shoeibi A, Ehdali Barabad N, Bakhshaee M. Causes of headache in patients with a primary diagnosis of sinus headache. Eur Arch Otorhinolaryngol. 2011;268(11):1593-6.

Friese KH, Zabalotnyi DI. Homeopathy in acute rhinosinusitis: a double-blind, placebo controlled study shows the efficiency and tolerability of a homeopathic combination remedy. HNO. 2007;55(4):271-7.

Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg. 2006;135(4):496-506.

Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007;(3):CD006394.

Helms S, Miller A. Natural treatment of chronic rhinosinusitis. Altern Med Rev. 2006;11(3):196-207.

Kaya A, Caliskan H. Does wet hair in cold weather cause sinus headache and posterior eye pain? A possible mechanism through selective brain cooling system. Med Hypotheses. 2012;79(6):744-5.

Kari E, DelGaudio JM. Treatment of sinus headache as migraine: the diagnostic utility of triptans. Laryngoscope. 2008;118(12):2235-9.

Karkos PD, Leong SC, Arya AK, Papouliakos SM, Apostolidou MT, Issing WJ. ‘Complementary ENT’: a systematic review of commonly used supplements. J Laryngol Otol. 2007;121(8):779-82.

Marmura MJ, Silverstein SD. Headaches caused by nasal and paranasal sinus disease. Neurol Clin. 2014; 32(2):507-23.

Mauskop A. Alternative therapies in headache. Is there a role? Med Clin North Am. 2001;85(4):1077-84.

Mehle ME, Kremer PS. Sinus CT scan findings in “sinus headache” migraineurs. Headache. 2008;48(1):67-71.

Melzer J, Saller R, Schapowal A, Brignoli R. Systematic review of clinical data with BNO-101 (Sinupret) in the treatment of sinusitis. Forsch Komplement Med. 2006;13(2):78-87.

Remedies for Sinus Headaches

Sinus headaches are caused by blocked sinuses, giving you pain and pressure around your sinuses, including between your eyes and above your nose. The pain can get worse when you move and the headache usually comes with other symptoms too, such as a stuffy nose or a sore throat. Experiencing a sinus headache can be tough, but there are remedies that can help you to deal with the problem.  

Dealing with the pain you’re experiencing is important, but it can also be necessary to consider treatments for the underlying cause of your sinus headaches too. An ear, nose and throat (ENT) doctor might prescribe certain medications or suggest treatments that you can try at home.

Over the counter (OTC) painkillers

Taking painkillers might not tackle the cause of your sinus headache, but it will give you temporary pain relief. Over-the-counter painkillers are an easy solution because they are readily available and effective. Medications such as acetaminophen and ibuprofen can give you the pain relief that you need. Make sure to use them according to the label so that you can ensure you’re using them safely.

Decongestants

Decongestants help by opening up your blocked sinuses to help relieve congestion. However, it’s important to be cautious when using them. If you use nasal decongestants for more than three days in a row, you could actually make your congestion worse. Oral decongestants should only be taken for a maximum of seven days. 

Decongestants are also available over the counter, so you don’t need a prescription. If you’re also taking painkillers, check the ingredients on the decongestants. Many decongestants also contain painkillers, so you need to be careful not to take too much by doubling up on medication.

Nasal steroid sprays

A nasal steroid spray is a treatment that your doctor might prescribe to you for particularly bad cases of blocked sinuses and sinus headaches. They are stronger medications that can help to reduce congestion and pain.

Antihistamines

Sometimes congestion can be caused by allergies, from seasonal allergies to environmental allergies. When this is the case, your doctor might recommend antihistamines, which can help with your sinus problems by treating the allergies.

Solutions for dry air

Dry air can irritate your sinuses, so ensuring it isn’t too dry can be helpful. You can use a humidifier or vaporizer to increase the humidity in your home. Other ways to benefit from using water include soaking a towel in warm water and holding it over your face for a few minutes. You can also use a saline solution nasal spray for the same purpose.

Salt water

Salt water can be used to flush out your sinuses and help to relieve sinus headaches. You can use a bulb syringe or a neti pot to carefully flush out your sinuses with salt water. It works by moistening and clearing out mucus, which should help to relieve the pressure and your headache. You should use distilled, sterile or boiled and then cooled water and make sure to wash out your neti pot or syringe after each use. A saline nasal spray does a similar job.

Avoid making symptoms worse

Various things can irritate your nasal passages, such as perfumes and cigarette smoke. Avoid the things that could make your symptoms worse if you want to deal with your sinus headache more quickly.

What to do when home remedies aren’t working

When you have a sinus headache, trying some treatments at home should be your first step. However, if you’ve tried a few things and nothing is helping, seeing a doctor can help you to get the right treatment and perhaps identify an underlying cause. You should also see a doctor if you have a fever, if there is pain or swelling of your face or eyes, redness around your eyes, cheeks, a severe headache, stiff neck or confusion.

After other treatments have been exhausted and your sinus problems are recurring, surgery might be suggested as an option for sinus headaches and blocked sinuses. This is something that you might discuss with your ENT to determine whether it’s the right choice for you and how it can help, as well as some of the risks that surgery can have. Before discussing surgery, it’s important to try other remedies to find out if any of them work.

If sinus headaches are a regular problem for you, Mountain Ear, Nose & Throat Associates can help. Contact us today at Sylva 828-586-7474, Franklin 828-524-5599, Murphy 828-835-1014 or New Asheville 828-458-8100 to schedule an appointment or learn more.

Pain in the head when bending over

Headache is unusually common. 90% of people have had at least one headache in their lifetime. In fact, it turns out that approximately 60% of the entire male population and 75% of the female population experienced at least one attack of headaches in the last month.

The most common cause of headache when bending over is sinusitis (also called sinusitis). With this disease, the head hurts in the eye sockets, cheekbones, cheeks, teeth may ache

Causes of pain in the head when bending over

Pain in the head when bending over is the first symptom of sinusitis. Characterized by headache – aggravated by tilting the head down, especially in the morning after waking up, localized in the superciliary region. There is difficulty in nasal breathing, more often bilateral, swelling of the skin in the area of ​​the cheek or eyelid on the affected side, if you gently press your finger on the points at the inner corner of the eye and in the middle of the cheek.

Acute sinusitis does not always begin with pain in the face. Difficulty breathing in one half of the nose may disturb, from which a purulent discharge with an unpleasant odor is released. In addition, there may be pain in the area of ​​​​the teeth of the upper jaw. For help in such cases, you should contact otorhinolaryngologist.

If you have a headache when bending over, you need to find out the true cause of the headache. One recent study found that out of 100 people who thought they had sinus headaches, almost 90% actually suffered from headaches due to 90,003 migraines.

Migraine headaches can also get worse when you lean forward and they can also be accompanied by nasal congestion . But migraine headaches are more likely to be aggravated by noise or light and may be accompanied by nausea.

Headache due to sinusitis often worries a woman during pregnancy. There are many herbs and medicines that pregnant and lactating women should not use. Check with your doctor before using herbs or supplements if you are pregnant or breastfeeding.

Bent over headache diagnosis

Your doctor will ask questions to distinguish sinus headache from migraine and tension headaches. If you have recently had a cold, allergy or symptoms of sinusitis, talking about it will help your doctor make a definitive diagnosis.

The ENT specialist will usually carefully examine the nose to check for sinus congestion and discharge. The doctor also presses on different areas of your face to test them for tenderness. The doctor can use lighting sinuses Check them for inflammation, and if no light shines through them, your sinuses may be congested with mucus.

If your doctor suspects that you have chronic sinusitis you may need to be tested:

If your doctor suspects an allergy that may be causing sinusitis , you may need to test for an allergy. You may need an additional referral to a specialist known as an ear, nose, and throat (ENT) doctor or otolaryngologist. This specialist can perform a nasal endoscopy using a fiber optic scope to clearly view the condition of the sinuses.

Bent over headache treatment

The best way to get rid of sinus headache that occurs when you tilt your head is to treat inflamed sinuses. Your doctor may prescribe antibiotics or corticosteroids.

Lifestyle changes are also needed, such as using a humidifier or irrigating the nasal passages with salt water. Some supplements and herbs can help prevent or shorten colds and flu. They can act on sinusitis in combination with antibiotics to treat infection and support the immune system. These treatments will help reduce sinus congestion and relieve headaches:

• using a humidifier.

• use of saline nasal spray.

• breathe over steam or in a steam room 2 to 4 times a day (for example, while sitting in a bathtub with a hot shower).

• treatment of allergic asthma attacks.

• other methods that may help headaches include.

• massage of painful areas of the head and neck.

• relaxation techniques.

Your doctor may prescribe antibiotics if he suspects you have a bacterial infection. For the treatment of acute sinusitis, you can go through course of treatment with antibiotics for 1-14 days. Treatment of chronic sinusitis may take longer, usually 3-4 weeks.

Some supplements may help prevent or treat headaches due to sinus congestion, or by reducing sinus inflammation . They can also help protect against colds. Because supplements can have side effects and interact with other medications, you should only take them under the supervision of a knowledgeable physician.

Probiotics, or “friendly” bacteria, may help if you are taking antibiotics for sinusitis. They may also reduce the chance of developing allergies. People who have weakened immune systems or who are taking drugs to suppress the immune system should ask their doctor before taking probiotics.

Headaches in the occipital, temporal, parietal and other areas. Causes. Treatment

Why does my head hurt?

Headache, as a rule, is not an independent disease, more often it is a manifestation or consequence of various diseases, including life-threatening ones, among them:

• Osteochondrosis of the cervical spine
• Herniated disc in the cervical spine
• Disk protrusion in the cervical spine
• Instability / displacement of the cervical vertebrae
• Muscle tone ical syndrome (muscle tension in the shoulder and neck areas)
• Cervical sciatica
• Vertebral artery syndrome
• Migraine
• Vertebrobasilar insufficiency
• Inflammation of the occipital nerve
• Shoulder-shoulder periarthrosis

9009 3 Cervical myositis

• Scoliosis
• Encephalopathy
• Oncological diseases of the brain
  (neoplasms)

How to get rid of a headache?

The question is quite complicated, and only an experienced neurologist can help. The success of treatment largely depends on how correctly the diagnosis is made.

The task of the doctor is to identify the root cause:

• Diseases of the brain (trauma, education, inflammation)
• Vascular problems (circulatory disorders of the brain)
• Diseases of the spine overvoltage, stress, high level anxiety, depression)
• Consequences of craniocerebral injuries, operations
• Extracerebral causes (hormonal disorders, infectious diseases, drugs, and chemicals)

The following methods are used to diagnose headaches:

• rare, frequent or constant pains
• aching pains, throbbing or sharp, shooting
• arising from certain movements (tilts, turns, etc.), weather changes, colds, lack of sleep, stress, etc.
• forehead, occiput, temples, right, left, etc.
• accompanied by other symptoms (nausea, dizziness, fever, eye pain, increased or decreased blood pressure,
  weakness, neck pain)