Did your doctor get it right?

By Stacey Colino

updated 2:44 p.m. ET Nov. 2, 2008

That facial pressure and stuffy nose can mean only one thing — sinus infection. Your doctor agrees and doles out antibiotics, but weeks later, your head still feels as if it’s in a vise. What gives? It could be a case of mistaken identity: Symptoms of one condition can mimic those of another, leading to treatment that is ineffective at best and that may allow the real problem to get worse. Don’t be fooled. Sleuth out what’s actually making you sick so you can find the right remedy and feel better fast.

The clue: A nagging cough
Plus shortness of breath and chest tightness: Your M.D. suspects bronchitis, a bacterial or viral infection of the bronchi, the lungs’ main airways.

The real culprit: Asthma, chronic inflammation of the bronchi

Solve the case: “Often asthma doesn’t cross a doctor’s radar unless a patient is wheezing or has a history of the condition,” says Michael Welch, M.D., codirector of the Allergy & Asthma Medical Group and Research Center in San Diego. “But you can develop cough-variant asthma—asthma without the wheezing—as an adult.” Both asthma and bronchitis come with a cough, but bronchitis can cause a wet cough and fever, which usually clears up on its own or with antibiotics within 10 days. The drier cough of a bout of asthma, on the other hand, can come and go for weeks or even months. Still not sure? Ask for a forced expiratory volume (FEV1) test, a lung-function screen. Abnormal results indicate asthma, and using a bronchodilator inhaler can help.

The clue: A racing heart
Plus a worried mind, shortness of breath and shakiness: Your doctor says it’s an anxiety attack, an emotional state marked by fear, apprehension or uneasiness.

The real culprit: Heart arrhythmia, an abnormal heart rate or rhythm such as beating too fast, too slow or irregularly

Solve the case: Symptoms of an anxiety attack and arrhythmia are nearly identical, and what’s worse, stress, anxiety or fear can also cause an arrhythmia—as can overdosing on stimulants such as caffeine or decongestants. “You need an electrocardiogram, a diagnostic test that records electrical currents in the heart, to detect abnormal rhythm,” says Nieca Goldberg, M.D., medical director of New York University Women’s Heart Program in New York City. “Arrhythmias may be a red flag for a serious underlying heart or thyroid problem, so call the doctor if your symptoms last more than a few minutes.” In addition to an ECG, your doctor should do a thorough physical exam and test your thyroid function. Many arrhythmias can be controlled with drugs or radio-frequency ablation, a nonsurgical procedure in which heat is used to destroy troublemaking tissue safely.

The clue: Sinus pain
Plus pressure, stuffiness and headache: You and your M.D. assume it’s a bacterial or fungal sinus infection.

The real culprit: Migraine, a severe headache linked to vascular (blood vessel) changes in the brain

Solve the case: One of the physiological responses to migraine is nasal congestion, which you can feel in the sinus passages and mistake for infection, according to Michael Benninger, M.D., chairman of the Head and Neck Institute at the Cleveland Clinic Foundation. Complicating matters, sinus infections can trigger migraines in people who are already susceptible to them. Besides being painful enough to put you out of commission for hours or even days, migraines are linked to an increased risk for depression and stroke, notes Dr. Vincent Martin, a professor of medicine at the University of Cincinnati College of Medicine. There’s also the concern that needlessly treating migraines (and other conditions) with antibiotics contributes to drug resistance.

One easy way to tell the difference between the two? Lie down. If it’s a sinus infection, feelings of facial pressure will likely get worse, whereas migraine symptoms should let up some. Migraine pain also tends to be severe, sudden and concentrated more on one side of the head, and it can make you nauseated and sensitive to light or noise. There is no single diagnostic test for either condition, but being specific about your symptoms and their duration with your physician can help her determine the true offender. A variety of pain medications (including over-the-counter and prescription nonsteroidal anti-inflammatory drugs and triptans, a class of headache drugs) are highly effective at warding off or halting migraine pain.

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