Prevalence and etiological causes of sinus headache in 113 consecutive patients with chronic rhinosinusitis

Abstract

The aim of this article is to examine the prevalence and etiological causes of sinus headache in patients with chronic rhinosinusitis. Patients who complained of sinus headache were identified and their presenting symptoms were analyzed in the light of the final diagnosis, made after surgical treatment and follow-up. The mean follow-up time for patients with sinus headache was 3.2 months (range, 4-16 months). Patients’ responses to treatment were classified under three categories; complete improvement, partial improvement and no response to treatment. Headache resolved completely in nine (34.6%) out of 26 patients diagnosed with chronic sinusitis and complaining of headache, while partial resolution was seen in five (19.2%) and no change in pain in 12 (46.1%).  Five patients with partial improvement and  12 patients with no improvement were re-evaluated through consultation with the neurology clinic. Eleven patients were diagnosed with migraine and five with tension type headache. No additional disease to sinusitis was determined in one patient. Sinonasal surgery may be beneficial in patients with primary headaches. We believe that a new diagnostic criterion for primary headache, whose etiology includes sinonasal pathologies, is now needed.

Keywords

• Headache, sinonasal pathologies, migraine

References

1. Fahy C, Jones NS. Nasal polyposis and facial pain. Clin Otolaryngol Allied Sci 2001; 26:510-513.
2. Hughes RG, Jones NS. The role of nasal endoscopy in outpatient management. Clin Otolaryngol Allied Sci 1998; 23:224-226.
3. Jones NS. Midfacial segment pain: implications for rhinitis and sinusitis. Curr Allergy Asthma Rep 2004; 4:187-192.
4. Fokkens W. Lund V. Bachert C et al. European Position Paper on Rhinosinusitis and nasal Polyps. Rhinology 2005; 18:1-87.
5. West B, Jones NS. Endoscopy-negative, computed tomography-negative facial pain in a nasal clinic. Laryngoscope 2001; 111:581-586.
6. Schreiber CP, Hutchinson S, Webster CJ et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Arch Intern Med 2004; 164:1769-1772.
7. Headache Classification Subcommittee of the International Headache Society. Classification of Headache Disorders, 2nd Edition. Cephalalgia 2004; 24: (Suppl. 1): 1-151.
8. Jones NS, Cooney TR. Facial pain and sinonasal surgery. Rhinology 2003; 41:193-200.

9. Welge-Luessen A, Hauser R, Schmid N, Kappos L, Probst R. Endonasal surgery for contact point headaches: a 10-year longitudinal study. Laryngoscope 2003; 113:2151-2156.
10. Steward MG. Sinus pain: is it real? Curr. Opin. Otolaryngol. Head Neck Surg 2002; 10:29-32.
11. Tarabichi M. Characteristics of sinus-related pain. Otolaryngology Head Neck Surg 2000; 122:842-847. Acquadro MA. Salman SD, Joseph MP. Analysis of pain and endoscopic sinus surgery for sinusitis. Ann Otol Rhinol Laryngol 1997; 106:305-309.
12. Hoffman SR, Dersarkissian RM, Buck SH, Stinziano GD, Buck GM. Sinus disease and surgical treatment: a results oriented quality assurance study. Otolaryngol Head Neck Surg 1989; 100:573-577.
13. Senior BA, Kennedy DW, Tanabodee J et al. Longterm results of functional endoscopic sinus surgery. Laryngoscope 1998: 108:151-157.
14. Gerbe RW, Fry TL, Fischer ND. Headache of nasal spur origin: an easily diagnosed and surgically correctable cause of facial pain. Headache 1984; 24:329-330.
15. Silberstein SD, Olesen J, Bousser MG et al. The International Classification of Headache Disorders, 2nd Edition (ICHD-II)--revision of criteria for 8.2 Medication-overuse headache. Cephalalgia 2005; 25:460-465.
16. Diener HC, Limmroth V. Medication-overuse headache: a worldwide problem. Lancet Neurol 2004; 3:475-483.