Sinus problems as a cause of headache refractoriness and migraine chronification

Abstract

Sinus headache is not a diagnostic term supported by the academia, yet it appears to be understood by the general public and larger medical community. It can be considered both a primary and secondary headache disorder. As a primary headache disorder, most of the patients considered to have sinus headache indeed have migraine (migraine with sinus symptoms). Yet it is also possible that some attacks of sinus headache may represent a unique clinical phenotype of migraine or be a unique clinical entity. Potentially, primary sinus headache can chronify and be refractory through immune-mediated mechanisms or as a catalyst for migraine chronification through ineffective treatment or medication overuse and misuse. As a secondary headache disorder, sinus headache can be associated with a wide range of underlying etiologies such as infection, anatomical abnormalities, trauma, and immunological disease or sleep disorders. It is possible that these underlying pathophysiological processes generate long-standing activation of nociceptive mechanisms involved in headache and can lead to chronification and refractoriness of the headache symptomatology. This article explores some of the potential mechanisms and the available scientific studies that may explain how sinus headache can become chronic and present to the clinician as a refractory headache disorder.

Diverse Physiological Roles of Calcitonin Gene-Related Peptide in Migraine Pathology: Modulation of Neuronal-Glial-Immune Cells to Promote Peripheral and Central Sensitization

“…Rhinosinusitis and temporomandibular joint disorder (TMD), which involve tissue inflammation and sensitization and activation of trigeminal ganglion neurons, are considered risk factors for migraine [24, 69]. The phenomenon of cross excitation within the trigeminal ganglion may help to explain why activation of one branch of the trigeminal ganglion can promote cellular changes associated with peripheral sensitization within the entire ganglion.…”

Chronic headaches and medication overuse

“…All acute drugs for the treatment of headache, including ergotamine derivatives, barbiturates, triptans, simple and combined analgesics and opioids, can in principle cause MOH. This observation, often sustained by robust clinical evidence, has been translated into the different subtypes of MOH as reported in the most recent classification of the International Headache Society [21]: ergotamine-overuse headache (8.2.1), triptan-overuse headache (8.2.2), analgesic-overuse headache (8.2.3), opioid-overuse headache (8.2.4) and combination analgesic-overuse headache (8.2.5). The possibility that nonspecific analgesic medicines contribute to MOH is indicated by the item medication-overuse headache attributed to the combination of acute medications (8.2.6).…”

“…The preexisting condition required to develop MOH is usually a primary headache, such as migraine of TTH. However, there is evidence that also patients affected by secondary headache disorders as post-traumatic headache [21,[23][24][25] can present with MOH. If drug overuse is required to develop MOH, several risk factors have been also described that may predispose or aggravate the condition.…”

Anatomical variations of nose causing rhinogenic contact point headache – a study at a tertiary care hospital of eastern India

“…5 Most relevant etiology concerned for otolaryngologists are anatomical variations of nose causing secondary headache which include septal deviation, septal spur and concha bullosa. 6 There are different types of septal deviations including cartilaginous deviation, bony deviation, bony spur and high septal deviation. The significant RCPH is seen in septal spur.…”