Abstract
The objectives of this study are to evaluate the patients who have sinus headaches, either self-ascribed or physician-diagnosed, and to determinate the response to sodium valproate in a prophylactic treatment of the patients without positive sino-nasal findings. “Sinus headache” is a patient’s complaint or physician-diagnosis that can have a variety of underlying causes. The patients are often treated with multiple courses of antibiotics and occasionally undergo a sinus surgery, often with little or no relief of their symptoms. One hundred and four patients with “sinus headaches” were evaluated prospectively. The patients with a normal rigid nasal endoscopy and a paranasal sinus computed tomography scan were treated with sodium valproate as a prophylactic treatment. After a 3-month follow-up, the patients’ response to the treatment was evaluated. Seventy-two patients (69.2%) did not have any positive sino-nasal findings in the nasal endoscopy and the computed tomography scanning. The response rate to the treatment for these patients was as follows: significant improvement in 44 patients (61.1%), partial response (9.7%), no response (15.3%), and ten patients (13.9%) withdrew or failed to follow-up. According to Wilcoxon test, the patients’ response rate to sodium valproate was statistically significant (P = 0.001). In conclusion, a majority of “sinus headache” patients do not show any positive sino-nasal pathologic finding. Therefore, we have to consider migraine headache as a considerable cause and sodium valproate as an effective conservative treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- EPOS:
-
European Position Paper on Rhinosinusitis and Nasal polyps
- IHS:
-
International Headache Society
- CT:
-
Computed tomography
- L–M score:
-
Lund–Mackay score
References
Levine HL, Setzen M, Cady RK et al (2006) An otolaryngology, neurology, allergy and primary care consensus on diagnosis and treatment of sinus headache. A literature review. Otolaryngol Head Neck Surg 134:516–523
Schor DI (1993) Headache and facial pain—the role of the paranasal sinuses: a literature review. Cranio 11:36–47
Couch JR (1988) Sinus headache: a neurologists viewpoint. Semin Neurol 8:298–302
Fokkens WJ, Lund VJ, Mullol J et al (2007) European Position Paper on Nasal polyps. Rhinology 45(Suppl 20):1–139
Headache Classification Committee of the International Headache Society (1988) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8(Suppl 7):1–96
Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders, 2nd edn. Cephalalgia 24(Suppl 1):9–160
Barbanti P, Fabbrini G, Pesare M, Vanacore N, Cerbo R (2002) Unilateral cranial autonomic symptoms in migraine. Cephalalgia 22:256–259
Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C (2004) Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. Arch Intern Med 164:1769–1772
Mehle ME, Kremer PS (2008) Sinus CT scan findings in “sinus headache” migraineurs. Headache 48:67–71
Eross E, Dodick D, Eross M (2007) The Sinus, Allergy and Migraine Study (SAMS). Headache 47:213–224
Scadding GK, Lund VJ (2004) Investigative rhinology. Taylor and Francis, London, p 96
Kari E, DelGaudio JM (2008) Treatment of sinus headache as migraine: the diagnostic utility of triptans. Laryngoscope 118:2235–2239
Cady RK, Schreiber CP (2002) Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology 58:S10–S14
Wolff H (1948) Headache and other pain. Oxford University Press, New York
Cady RK, Schreiber CP (2004) Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 37:267–288
Ishkanian G, Blumenthal H, Webster CJ, Richardson MS, Ames M (2007) Efficacy of sumatriptan tablets in migraineurs self-described or physician-diagnosed as having sinus headache: a randomized, double-blind, placebo-controlled study. Clin Ther 29:99–109
Dowson A, Dahlof A, Tepper S et al (2004) The prevalence and diagnosis of migraine in a primary care setting-insights from the landmark study. Headache Care 1(2):137–139
Tepper SJ (2004) New thoughts on sinus headache. Allergy Asthma Proc 25(2):95–96
Shields G, Seikaly H, LeBoeuf M et al (2003) Correlation between facial pain or headache and computed tomography in rhinosinusitis in Canadian and US subjects. Laryngoscope 113:943–945
Paulson EP, Graham SM (2004) Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain. Laryngoscope 114:1992–1996
Mulleners WM, Chronicle EP (2008) Anticonvulsants in migraine prophylaxis: a cochrane review. Cephalalgia 28:585–597
Conflict of interest statement
This study was not a sponsored research and we had no financial relationship with any sponsor.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dadgarnia, M.H., Atighechi, S. & Baradaranfar, M.H. The response to sodium valproate of patients with sinus headaches with normal endoscopic and CT findings. Eur Arch Otorhinolaryngol 267, 375–379 (2010). https://doi.org/10.1007/s00405-009-1090-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-009-1090-9