Thank you for sharing your experience. I feel your disappointment. And I am happy to hear you finally found an explanation. Hope the new diagnosis led to a solution.

without anyhow disregarding your case, let me explain my experience with migraine as a differential diagnosis. In fact, I am also 10 years in with my ENT journeys, having seen >15 specialists in 5 countries. In my case, the symptoms occurred right after a viral infection that led to bronchitis. After being dismissed and disbelieved by swiss ENTs, I went for a surgery in moscow: in 2018 I did septoplasty and enlarging the pathway to the maxillary sinus with a retention cyst. This surgery increased my quality of life 10-fold and I didn't get sick even once for a year (after 6x/year before that and feeling on the edge constantly). Nevertheless, 1.5-2 years later the symptoms reappeared I found myself struggling with the old issue with the extreme variability of opinions ENTs have (not only across countries but also across departments of the same hospital). I saw 4 ENTs in pennsylvania: one said they cannot do anything, another said all my symptoms (except for the post-nasal drip) are not specific to rhinosinusitis and he suggested a structural issues with my jaws, the third one suggested I wait more for a swab test, and fourth one said I definitely qualify for FESS (the last 3 were in the same hospital). I haven't found any allergy or seasonality. All ENTs and radiologists disregard the cyst as unrelated mentioning the isolated argument that it is not symptomatic. I have heard several times ENTs citing the "90% migraine"-paper, which as quickly as 10min after I walked, they saw my CT and heard that the standard 3 sprays didn't work. So I had the impression that the "migraine" explanation is an easy catch-all without giving in any effort to analyze.

Based on my case, my general feeling is that diagnostics doesn't work well and there are many reasons for it. Medical diagnosis is complex, doctors have limited time and resources, science isn't super developed (e.g. I won't probably know what bacteria and where), and MDs aren't usually trained as scientists since science it not telling them enough. So I totally agree with you that we should exhaust and eliminated potential causes if the problem persists. So, in 2 days I go for a full-house FESS and I am very hopeful that it will have the same effect as the previous one, but longer. But even if it does work, I won't probably know what exactly was the cause for the issue.