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The Sinus Headache Explained

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Abstract

The concept of a sinus headache is problematic from neurology, allergology, and rhinology perspectives. It may be considered the final neurological diagnosis of exclusion when criteria for other craniofacial pain syndromes are not met. The International Headache Society definition implicates the presence of acute sinusitis, but this requirement is often not met in practice or with a patient’s perception of the term. Otorhinolaryngologists have a similar exasperation with this cephalgia but tend to attribute idiopathic, nonallergic rhinopathy as the cause. Allergists often see patients who claim to have a sinus headache but instead have perennial allergic rhinitis or nonallergic rhinitis. A fresh perspective is required to determine the characteristics, differential diagnosis, and veracity of the sinus headache. We recommend using the term with caution only if the clinical picture meets the criteria for acute sinusitis–induced headache.

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References

Papers of particular interests, published recently, have been highlighted as:• Of importance •• Of major importance

  1. Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24(Suppl 1):9–160.

    Google Scholar 

  2. GlaxoSmithKline: Migraine Consumer Segmentation Study. Research Triangle Park, NC: GlaxoSmithKline; 2001.

    Google Scholar 

  3. Eross EJ: Poster presented at the International Headache Congress. Rome, Italy; September 13–16, 2003.

  4. 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;164:1769–72.

    Article  PubMed  Google Scholar 

  5. Perry BF, Login IS, Kountakis SE: Nonrhinologic headache in a tertiary rhinology practice. Otolaryngol Head Neck Surg 2004;130:449–52.

    Article  PubMed  Google Scholar 

  6. Couch JR: Sinus headache: a neurologist’s viewpoint. Semin Neurol 1988;8:298–302.

    Article  CAS  PubMed  Google Scholar 

  7. Cady RK, Schreiber CP: Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology 2002;58(9 Suppl 6):S10–4.

    PubMed  Google Scholar 

  8. •• Supiot F: [Migraine in 2009: from attack to treatment.] Rev Med Brux 2009;30:399–403 This is an excellent review of migraine headache diagnosis and treatment options.

    CAS  PubMed  Google Scholar 

  9. Kelman L: The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs. Headache 2004;44:865–72.

    Article  PubMed  Google Scholar 

  10. Silberstein SD: Atlas of migraine and other headaches. London: Taylor & Francis; 2005.

    Google Scholar 

  11. Truong T, Slavin L, Kashani R, et al.: Prevalence of migraine headaches in patients with congenital heart disease. Am J Cardiol 2008;101:396–400.

    Article  PubMed  Google Scholar 

  12. Yoon MS, Mueller D, Hansen N, Poitz F, Slomke M, Dommes P, Diener H, Katsarava Z, Obermann M: Prevalence of facial pain in migraine: a population-based study. Cephalalgia 2009. doi:10.1111/j.1468-2982.2009.01899.x

  13. • Kalita J, Yadav RK, Misra UK: A comparison of migraine patients with and without allodynic symptoms. Clin J Pain 2009;25:696–8 Allodynia indicates sensitization of the central nociceptive system such that minor stimuli lead to pain. This may indicate a more severe neurological effect and potentially be a step in the progression to chronic, severe, daily headaches.

    Article  PubMed  Google Scholar 

  14. Sluder G: Headaches and Eye Disorders of Nasal Origin. London: Henry Kimpton; 1919.

    Google Scholar 

  15. McAuliffe GW, Goodell H, Wolff HG: Experimental studies on headache: pain from the nasal and paranasal structures. Res Publ Assoc Res Nerv Ment Dis 1943;23:185–208.

    Google Scholar 

  16. Stammberger H, Wolf G: Headaches and sinus disease: the endoscopic approach. Ann Otol Rhinol Laryngol Suppl 1988;134:3–23.

    CAS  PubMed  Google Scholar 

  17. Welge-Luessen A, Hauser R, Schmid N, et al.: Endonasal surgery for contact point headaches: a 10-year longitudinal study. Laryngoscope 2003;113:2151–6.

    Article  PubMed  Google Scholar 

  18. Abu-Bakra M, Jones NS: The prevalence of nasal contact points in a population with facial pain and a control population. J Laryngol Otol 2001;115:626–32.

    Article  Google Scholar 

  19. Shields G, Seikaly H, LeBoeuf M, et al.: Correlation between facial pain or headache and computed tomography in rhinosinusitis in Canadian and U. S. subjects. Laryngoscope 2003;113:943–5.

    Article  PubMed  Google Scholar 

  20. Bhattacharyya T, Piccirillo J, Wippold FJ: Relationship between patient-based descriptions of sinusitis and paranasal sinus computed tomographic findings. Arch Otolaryngol Head Neck Surg 1997;123:1189–92.

    CAS  PubMed  Google Scholar 

  21. Tarabichi M: Characteristics of sinus-related pain. Otolaryngol Head Neck Surg 2000;122:842–7.

    Article  CAS  PubMed  Google Scholar 

  22. DeWeese DD, Saunders HW: The nasal septum: rhinoplasty; maxillary and nasal fractures. In Textbook of Otolaryngology. Edited by DeWeese DD, Saunders HW. St. Louis, MO: C. V. Mosby; 1977:210–24.

    Google Scholar 

  23. Baraniuk JN, Malekzadeh S, Casado B: Chronic rhinosinusitis with glandular hypertrophy. Clin Allergy Immunol 2007;20:121–46.

    CAS  PubMed  Google Scholar 

  24. Dutt SN, Kameswaran M: The aetiology and management of atrophic rhinitis. J Laryngol Otol 2005;119:843–52.

    PubMed  Google Scholar 

  25. Moore EJ, Kern EB: Atrophic rhinitis: a review of 242 cases. Am J Rhinol 2001;15:355–61.

    CAS  PubMed  Google Scholar 

  26. Ly TH, deShazo RD, Olivier J, et al.: Diagnostic criteria for atrophic rhinosinusitis. Am J Med 2009;122:747–53.

    Article  PubMed  Google Scholar 

  27. •• Jones NS: Midfacial segment pain: implications for rhinitis and rhinosinusitis. Clin Allergy Immunol 2007;19:323–33 The concept of midfacial pain provides a new framework for understanding and treating patients with nasal and sinus region complaints but few physical findings of mucosal disease.

    PubMed  Google Scholar 

  28. Senbil N, Gürer YK, Uner C, Barut Y: Sinusitis in children and adolescents with chronic or recurrent headache: a case-control study. J Headache Pain 2008;9:33–6.

    Article  PubMed  Google Scholar 

  29. • Kari E, DelGaudio JM: Treatment of sinus headache as migraine: the diagnostic utility of triptans. Laryngoscope 2008;118:2235–39 This prospective study evaluated sinus headache patients and identified a high proportion who actually had migraine headaches. Triptan drugs were effective at relieving the pain from the headaches.

    Article  CAS  PubMed  Google Scholar 

  30. Peres MF, Zukerman E, Young WB, Silberstein SD: Fatigue in chronic migraine patients. Cephalalgia 2002;22:720–24.

    Article  CAS  PubMed  Google Scholar 

  31. Naranch K, Park YJ, Repka-Ramirez MS, et al.: A tender sinus does not always mean rhinosinusitis. Otolaryngol Head Neck Surg 2002;127:387–97.

    Article  CAS  PubMed  Google Scholar 

  32. Ku M, Silverman B, Prifti N, et al.: Prevalence of migraine headaches in patients with allergic rhinitis. Ann Allergy Asthma Immunol 2006;97:226–30.

    Article  PubMed  Google Scholar 

  33. Enberg RN: Perennial nonallergic rhinitis: a retrospective review. Ann Allergy 1989;63:513–6.

    CAS  PubMed  Google Scholar 

  34. Berg O, Carenfelt C: Analysis of symptoms and clinical signs in the maxillary sinus empyema. Acta Otolaryngol 1988;105:343–9.

    Article  CAS  PubMed  Google Scholar 

  35. Mudgil SP, Wise SW, Hopper KD, et al.: Correlation between presumed sinus-induced pain and paranasal sinus computed tomographic findings. Ann Allergy Asthma Immunol 2002;88:223–6.

    Article  PubMed  Google Scholar 

  36. Busaba NY, Sin HJ, Salman SD: Impact of gender on clinical presentation of chronic rhinosinusitis with and without polyposis. J Laryngol Otol 2008;122:1180–4.

    Article  CAS  PubMed  Google Scholar 

  37. Cady RK, Schreiber CP: Sinus problems as a cause of headache refractoriness and migraine chronification. Curr Pain Headache Rep 2009;13:319–25.

    Article  PubMed  Google Scholar 

  38. West B, Jones NS: Endoscopy-negative, computed tomography-negative facial pain in a nasal clinic. Laryngoscope 2001;111:581–6.

    Article  CAS  PubMed  Google Scholar 

  39. Royal College of Radiologists Working Party: Making the Best Use of a Department of Clinical Radiology: Guidelines for Doctors, edn 3. London: Royal College of Radiologists; 1995.

    Google Scholar 

  40. Jones NS, Strobl A, Holland I: CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol 1997;22:47–51.

    Article  CAS  PubMed  Google Scholar 

  41. Jones NS: A review of the CT staging systems, the prevalence of anatomical variations, incidence of mucosal findings and their correlation with symptoms, surgical and pathological findings. Clin Otolaryngol 2002;27:11–7.

    Article  CAS  PubMed  Google Scholar 

  42. Lloyd GA: CT of the paranasal sinuses: study of a control series in relation to endoscopic sinus surgery. J Laryngol Otol 1990;104:477–481.

    Article  CAS  PubMed  Google Scholar 

  43. Marshall A, Jones NS: The utility of radiological studies in the diagnosis and management of rhinosinusitis. Curr Infect Dis Rep 2003;5:199–204.

    Article  PubMed  Google Scholar 

  44. Cooney TR, Huissoon AP, Powell RJ, et al.: Investigation for immunodeficiency in patients with recurrent ENT infections. Clin Otolaryngol 2001;26:184–188.

    Article  CAS  PubMed  Google Scholar 

  45. Chee L, Graham S, Carothers DG, et al.: Immune dysfunction in refractory sinusitis in a tertiary care setting. Laryngoscope 2001;111:233–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by US Public Health Service Award RO1 ES015382 from the National Institute of Environmental and Health Sciences; Department of Defense Congressionally Directed Medical Research Program W81XWH-07-1-0618; and M01–RR13297 from the General Clinical Research Center Program, National Center for Research Resources, National Institutes of Health.

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Division of Rheumatology, Immunology, and Allergy, Georgetown University Medical Center, Room 3004-F, 3rd Floor, PHC Building, 3800 Reservoir Road NW, Washington, DC, 20007-2197, USA

    Murugan Ravindran & James N. Baraniuk

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  1. Murugan Ravindran
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  2. James N. Baraniuk
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Correspondence to Murugan Ravindran.

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Ravindran, M., Baraniuk, J.N. The Sinus Headache Explained. Curr Allergy Asthma Rep 10, 202–209 (2010). https://doi.org/10.1007/s11882-010-0095-1

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