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Suzaki I, Miyoshi N, Ishima T, Hirano K, Shimane T. Successful Omalizumab Treatment of Rhinogenic Contact Point Headache Complicated by Severe Cedar Pollinosis: A Case Report. Cureus 2023; 15:e51046. [PMID: 38264387 PMCID: PMC10805559 DOI: 10.7759/cureus.51046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
Headache is one of the most common neurological disorders in children. The most common headache in children is a primary headache, including migraine and tension-type headache, but note that secondary headaches should be differentiated as a cause of headache in pediatric patients. The management of cedar pollinosis in pediatric patients is important because it can cause quality-of-life deficits in addition to nasal and ocular symptoms. Omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, is approved in Japan as an add-on treatment option for severe cedar pollinosis, but few studies have investigated its real-world clinical efficacy in pediatric patients with seasonal allergic rhinitis. We report the case of a 15-year-old male patient with cedar pollinosis who suffered from uncontrolled naso-ocular symptoms, facial pain, and headache despite using histamine H1-receptor antagonists and intranasal corticosteroid spray. A sinus computed tomography scan and nasal endoscopic findings showed a swollen inferior turbinate and nasal septum in contact with the nasal cavity ipsilateral to the headache. Application of local anesthesia to the contact points within the nasal cavity resulted in the rapid relief of headaches. Therefore, we diagnosed rhinogenic contact point headache triggered by cedar pollinosis and initiated the add-on therapy of omalizumab for seasonal allergic rhinitis. Three days after the administration of omalizumab, his naso-ocular symptoms, quality-of-life deficits, and headache improved markedly, accompanied by improved nasal endoscopic findings. Omalizumab was immediately effective for the treatment of rhinogenic contact point headaches complicated by severe cedar pollinosis in a pediatric patient.
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Affiliation(s)
- Isao Suzaki
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Naoto Miyoshi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Takahiro Ishima
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Kojiro Hirano
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Toshikazu Shimane
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
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Folic MM, Barac AM, Ugrinovic AB, Jotic AD, Trivic AS, Milovanovic JP, Borozan NN, Peric AR, Stevanovic G, Krejovic-Trivic SB, Cvorovic L, Stojkovic GM. Effectiveness of the Treatment of Rhinogenic Headache Caused by Intranasal Contact. EAR, NOSE & THROAT JOURNAL 2023; 102:605-610. [PMID: 34077274 DOI: 10.1177/01455613211019706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of the study is to evaluate the effectiveness of the surgical and nonsurgical treatment of headache caused by contact points (CPs) between the nasal septum and inferior or middle turbinate. METHODS The research was designed as a prospective clinical case-series study. The patients with CP headaches were offered to choose between 2 treatment options, surgery and medical treatment. Two groups of surgically treated patients (surgery groups 1 and 2, depending on whether there is a contact between nasal septum and inferior turbinate or middle turbinate) were evaluated and compared for headache intensity and frequency. Headache intensity was measured using a visual analog scale value from 0 to 10; the frequency of headache was expressed as the number of days during 1 month with a headache (before surgery, 1 month, and 6 months after surgery). A comparison was also made between surgically and nonsurgically treated patients. RESULTS We found more intensive and frequent headache in patients who had CP between the nasal septum and the middle turbinate (P = .038 and P = .003, respectively). A significant reduction in headache intensity and frequency was found in both groups of surgically treated patients 6 months after surgery; however, this reduction was more significant in patients with mucosal contact between nasal septum and middle turbinate. The nonsurgical treatment made a significant reduction of headache intensity and frequency at 1-month follow-up (P = .012 and P = .031, respectively), but not at 6-month follow-up (P = .114 and P = .088, respectively). CONCLUSION Surgery gave a statistically significant reduction in the intensity and frequency of headache, which was assessed 6 months after surgery. Surgery was found as superior to nonsurgical treatment in the therapy of CP headache.
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Affiliation(s)
- Miljan M Folic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra M Barac
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Aleksandar B Ugrinovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana D Jotic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandar S Trivic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Jovica P Milovanovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | | | - Aleksandar R Peric
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Goran Stevanovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja B Krejovic-Trivic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Ljiljana Cvorovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Goran M Stojkovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
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Patel VA, Liaw J, Saadi RA, Isildak H, Polster SP, Kalmar CL. Headache Diagnosis in Children and Adolescents. Otolaryngol Clin North Am 2022; 55:633-647. [PMID: 35490042 DOI: 10.1016/j.otc.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric headache is a common medical complaint managed across multiple subspecialties with a myriad of unique factors (clinical presentation and disease phenotype) that make accurate diagnosis particularly elusive. A thorough understanding of the stepwise approach to headache disorders in children is essential to ensure appropriate evaluation, timely diagnosis, and efficacious treatment. This work aims to review key components of a comprehensive headache assessment as well as discuss primary and secondary headache disorders observed in children, with a particular focus on clinical pearls and "red flag" symptoms necessitating ancillary diagnostic testing.
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Affiliation(s)
- Vijay A Patel
- Division of Otolaryngology - Head & Neck Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard MS #58, Los Angeles, CA 90027, USA.
| | - Jeffrey Liaw
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri, Columbia, MO, USA
| | - Robert A Saadi
- Department of Otolaryngology - Head & Neck Surgery, University of Arkansas, Little Rock, AR, USA
| | - Huseyin Isildak
- Department of Otolaryngology - Head & Neck Surgery, Stony Brook University, East Setauket, NY, USA
| | - Sean P Polster
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher L Kalmar
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Maniaci A, Lechien JR, Calvo-Henriquez C, Iannella G, Leigh S, Ingrassia A, Merlino F, Bannò V, Cocuzza S, La Mantia I. Long-term stability of outcomes of endoscopic surgery for rhinogenic contact point headache (Sluder''s neuralgia). Am J Otolaryngol 2022; 43:103368. [PMID: 35038648 DOI: 10.1016/j.amjoto.2021.103368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy.
| | - Jerome Rene Lechien
- Research Committee of the Young Otolaryngologists, International Federations of ORL Societies, Paris, France; Department of Human Anatomy and Experimental Oncology, School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital (University of Paris-Saclay), Paris, France
| | - Christian Calvo-Henriquez
- Task Force COVID-19 of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Sowerby Leigh
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ont. Leigh, Canada.
| | - Angelo Ingrassia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Vittoria Bannò
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
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Abstract
Endoscopic nasal septoplasty is a commonly performed otolaryngology procedure, not known to cause persistent postsurgical pain or hypersensitivity. Here, we discuss a unique case of persistent nasal pain that developed after a primary endoscopic septoplasty, which then progressed to marked mechanical and thermal allodynia following a revision septoplasty. Pain symptoms were found to be mediated by the maxillary division of the trigeminal nerve and resolved after percutaneous radiofrequency ablation (RFA) of bilateral maxillary nerves. To the best of our knowledge, this is the first report of maxillary nerve–mediated nasal allodynia after septoplasty.
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Sinus, disabling tension-type, and temporomandibular joint headaches. Curr Opin Neurol 2021; 34:344-349. [PMID: 33709975 DOI: 10.1097/wco.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Clinicians frequently face questions from headache patients regarding the roles played by sinus issues, muscle tension, and temporomandibular joint (TMJ) problems. This review highlights new concepts regarding the diagnosis and management of these headache conditions and their differentiation from migraine. RECENT FINDINGS Recent research has clarified the roles played by pathology in the paranasal sinuses and TMJ in patients reporting headache. Additional information from physiologic studies in patients with tension-type headache (TTH) has improved the understanding of this condition. SUMMARY Improved understanding of sinus headache, disabling TTH, and TMJ headache and their differentiation from migraine will lead to reductions in unnecessary diagnostic procedures and unwarranted medical and surgical procedures. More expedient recognition of the origin of headache should lead to improved therapeutic outcomes.
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