Sinus Headache: A Neurology, Otolaryngology, Allergy, and Primary Care Consensus on Diagnosis and Treatment

Abstract

Sinus headache is a widely accepted clinical diagnosis, although many medical specialists consider it an uncommon cause of recurrent headaches. The inappropriate diagnosis of sinus headache can lead to unnecessary diagnostic studies, surgical interventions, and medical treatments. Both the International Headache Society and the American Academy of Otolaryngology-Head and Neck Surgery have attempted to define conditions that lead to headaches of rhinogenic origin but have done so from different perspectives and in isolation of each other. An interdisciplinary ad hoc committee convened to discuss the role of sinus disease as a cause of headache and to review recent epidemiological studies that suggest sinus headache (headache of rhinogenic origin) and migraine are frequently confused with one another. This committee reviewed available scientific evidence from multiple disciplines and concluded that considerable research and clinical study are required to further understand and delineate the role of nasal pathology and autonomic activation in migraine and headaches of rhinogenic origin. However, this group agreed that greater diagnostic and therapeutic attention needs to be given to patients with sinus headaches.

Neurovascular Pains: Implications of Migraine for the Oral and Maxillofacial Surgeon

“…The individuals with migraine headache have specific issues unique to them that may alter the ultimate course of treatment. The two most compelling arguments for knowing about migraine and other headache disorders is because they may present as non-odontogenic reasons for toothache [29] and sinus pain [111], as well as the possibility that life-threatening pathological processes may be present. Such pains are known to motivate individuals to be evaluated by their dentists, suggesting that dental specialists should be familiar with these concepts and the diagnostic process.…”

“…This disorder, which likely is associated with genetic alterations such as calcium channel abnormalities [53,54] and serotonin receptor activity [109,110], has a centrally generated trigger [111] that results in vasodilatation and primary afferent nociceptor hypersensitivity [91]. This results in lower sensory thresholds during the migraine headache attack [96,97].…”

Prevalence of sinusitis and mastoiditis in headache

“…Contact points detected in septum, and conchae should be treated surgically in suitable patients. [14] The association between insufficiently aerated mastoid bone, and atelectatic nasal diseases of the mastoid bone, cholesteatoma, and chronic otitis media with effusion has been already demonstrated. [7,15] Since mastoid air cell system develops in three dimensions within the temporal bone, some strategies have been evolved to obtain 3-D images from 2-D computed tomograms, and tomographic radiograms.…”

Endoscopic sinus surgery in individuals with facial pain due to chronic maxillary sinusitis ? a functional controlled study

“…Sinus headache is a term widely assigned to individuals with facial pain. The inappropriate diagnosis of sinus headache can lead to unnecessary diagnostic studies, surgical interventions, and medical treatments 5,6 . Although the vast majority of individuals diagnosed as having sinus headaches represent diagnostic errors, headache and facial pain of rhinogenic origin are real and often seen in clinical practice 7 .…”

“…Although the vast majority of individuals diagnosed as having sinus headaches represent diagnostic errors, headache and facial pain of rhinogenic origin are real and often seen in clinical practice 7 . In some circumstances, the etiology of pain resides on the maxillary sinuses and is secondary to chronic infection 5,6 . Surgeries are sometimes indicated to treat these cases 6 .…”