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Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana. Radiol Res Pract 2022; 2022:4736455. [PMID: 36248021 PMCID: PMC9553476 DOI: 10.1155/2022/4736455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Contrast medium (CM) administration during computed tomography (CT) enhances the accuracy in the detection and interpretation of abnormalities. Evidence from literature also validate the essence of CM in imaging studies. CT, by virtue of its ubiquity, ease of use, speed, and lower financial footprint, is usually the first investigation in cases of headache. Through a multicenter retrospective analysis, we compared findings of contrast-enhanced CT (CECT) to noncontrast-enhanced CT (NCECT) head examinations among patients presenting with headache. Methods A multicenter retrospective analysis of four years' CT head examination data at two radiology centers located in Central and Western Regions of Ghana were reviewed. Records of patients who presented with headache as principal complaint between January 2017 and December 2020 were reviewed. A total of 477 records of patients with headache were identified, retrieved and evaluated. A Chi-square test and Fisher exact test were used to compare the CECT and NCECT groups. Binary logistic regression analysis was computed to assess association between CECT and each CT findings. Statistical significance was considered at p < 0.05 with a 95% confidence interval. Results A significant proportion of the patients was females (51.8% in CECT and 60% in NCECT). The NCECT group (40.06 ± 14.76 years) was relatively older than the CECT group (38.43 ± 17.64 years). There was a significant difference between the CECT and NCECT in terms of age (p=0.002) and facility CT was performed (p < 0.0001). The rate of abnormalities was higher in CECT (43.5%, 166/382) compared NCECT (37.9%, 36/95). There was no significant association between CT head findings and contrast enhancement. Conclusion CECT examination accounted for 5.6% increase in the detection of head abnormalities. Efforts required to establish local standard operation procedures (SOPs) for contrast medium use especially in CT head examinations. Further studies to improve the knowledge of agents, mechanism of action, and safety of contrast media used among practitioners in Ghana is recommended.
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Plawecki AM, Saleem A, Zvirbulis D, Peterson EL, Yoo F, Ali A, Craig JR. Clinical Features and Headache Diagnoses in Patients With Chief Complaint of Craniofacial Pain. Ann Otol Rhinol Laryngol 2022; 132:628-637. [PMID: 35794798 DOI: 10.1177/00034894221111254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Investigate the use of nasal endoscopy, sinus imaging, and neurologic evaluation in patients presenting to a rhinologist primarily for craniofacial pain. METHODS This was a retrospective analysis of consecutive outpatients presenting to a rhinologist between 2016 and 2019 with chief complaints of craniofacial pain with or without other sinonasal symptoms, who were then referred to and evaluated by headache specialists. Data analyzed included sinusitis symptoms, Sino-Nasal Outcome Test (SNOT-22) scores (and facial pain subscores), pain location, nasal endoscopy, computed tomography (CT) findings, and headache diagnoses made by headache specialists. RESULTS Of the 134 patients with prominent craniofacial pain, the majority of patients were diagnosed with migraine (50%) or tension-type (22%) headache, followed by multiple other non-sinogenic headache disorders. Approximately 5% of patients had headaches attributed to sinusitis. Amongst all patients, 90% had negative nasal endoscopies. Patients with negative endoscopies were significantly less likely to report smell loss (P = .003) compared to those with positive endoscopies. Poor agreement was demonstrated between self-reported pain locations and sinus findings on CT (kappa values < 0.20). Negative nasal endoscopy showed high concurrence with negative CT findings (80%-97%). CONCLUSIONS Patients presenting with chief complaints of craniofacial pain generally met criteria for various non-sinogenic headache disorders. Nasal endoscopy was negative in 90% of patients, and CT demonstrated poor agreement with pain locations. Nasal endoscopy and CT shared high concurrence rates for negative sinus findings. The value of nasal endoscopy over sinus imaging in craniofacial pain evaluation should be explored in future studies.
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Affiliation(s)
- Andrea M Plawecki
- Department of Otolaryngology-Head & Neck Surgery, Henry Ford Health, Detroit, MI, USA
| | - Abdulmalik Saleem
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Dace Zvirbulis
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Edward L Peterson
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Frederick Yoo
- Department of Otolaryngology-Head & Neck Surgery, Kaiser Permanente, Orange County, CA, USA
| | - Ashhar Ali
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - John R Craig
- Department of Otolaryngology-Head & Neck Surgery, Henry Ford Health, Detroit, MI, USA
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Velasquez N, DelGaudio JM. The Role of the Otolaryngologist in the Evaluation and Management of “Sinus Headache”. Otolaryngol Clin North Am 2022; 55:501-518. [DOI: 10.1016/j.otc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miglani A, Soler Z, Schlosser RJ. Novel Devices for Sinus Headache. Otolaryngol Clin North Am 2022; 55:519-529. [PMID: 35477843 DOI: 10.1016/j.otc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Novel medical devices are emerging as low-risk treatment options for patients suffering from sinus headaches. Early trends for the treatment of sinus headaches using medical devices are following the more established primary headache literature. There are two categories of devices with early data supporting use, which may serve as useful adjuncts to conventional pharmacotherapy in the management of sinus headaches not caused by sinusitis: transcutaneous electrical neurostimulation and acoustic vibration with oscillating expiratory pressure. There is currently a paucity of high-level evidence and further studies are needed. Initial reports suggest these interventions are low risk, but longer follow-up is necessary.
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Affiliation(s)
- Amar Miglani
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Rutledge Tower,135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
| | - Zachary Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Rutledge Tower,135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Rutledge Tower,135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA; Department of Surgery, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA
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Rhinogenic and sinus headache - Literature review. Am J Otolaryngol 2021; 42:103113. [PMID: 34175774 DOI: 10.1016/j.amjoto.2021.103113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Headache is a common, yet challenging symptom to evaluate given its wide range of clinical presentations and different etiologies. For centuries, conceptual understanding of headache causation has been attributed to anatomic abnormalities of the nose and paranasal sinuses. METHODS Structured literature review. RESULTS The number of cases, categorized as migraines or other primary headaches, misdiagnosed as a "sinus headache" is high in the literature, ranging from 50 to 80%. The potential mechanisms for rhinogenic headaches were classically described as pain secondary to prolonged mucosal contact points, hypoxia in the paranasal sinuses secondary to poor ventilation, or pressure caused by the growth of nasal polyps. Additionally, other mechanisms were described and are still being studied. Corrective surgery for mucosal contact points in the nasal cavity is deemed necessary for relieving the headache, although patient outcomes are variable. CONCLUSION Delay in proper diagnosis and treatment negatively impact patient quality of life. Most cases of "sinus headache" or "rhinogenic headache" seen in clinical practice are in fact misdiagnosed as either primary headaches or migraines. Because of increased misdiagnoses, Otolaryngologists should establish a direct and precise diagnosis congruent with a chief complaint being a headache. Vital information such as a good clinical history, well-performed nasal endoscopy, and occasional CT scan may decrease misdiagnosis probability.
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Guirguis D, Kashat L, Moradi S, Bonaiuto GS. An Unusual Source of Sinonasal Disease in an Immunocompromised Patient: A Case Report of the Clinical Presentation, Diagnosis, and Treatment of Acanthamoeba Rhinosinusitis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP316-NP319. [PMID: 33095663 DOI: 10.1177/0145561320968936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic nasal crusting is a commonly encountered entity in an otolaryngology office. Progressive, extensive nasal crusting with erosion is relatively unusual, however. We present the case a 58-year-old renal transplant patient with a history of vasculitis and immunosuppression who presents with subjective headache and facial pain, nasal crusting, and isolated left ethmoid sinusitis. She developed extensive intranasal necrosis and underwent multiple endoscopic sinus surgeries with intraoperative biopsies, which played a critical role in her workup and eventual diagnosis of Acanthamoeba rhinosinusitis. Although she endured a difficult course, proper diagnosis and treatment allowed for her recovery over time. The differential diagnosis for intranasal necrosis is often broad. This case highlights the wide range of etiologies to be considered in a patient with extensive nasal crusting and erosion/necrosis, and the importance of thorough diagnostic evaluation in these patients, especially those in an immunocompromised state.
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Affiliation(s)
- David Guirguis
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Lawrence Kashat
- Department of Otolaryngology-Head and Neck Surgery, PGY-5 University of Connecticut, Farmington, CT, USA
| | - Sara Moradi
- Department of Pathology, PGY-2 Hartford Hospital, Farmington, CT, USA
| | - Gregory S Bonaiuto
- Department of Otolaryngology-Head and Neck Surgery, Hartford Hospital, Hartford, CT, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate and explain our current understanding of rhinogenic headache in the pediatric population. RECENT FINDINGS One study showed that 40 % of pediatric patients with migraine had previously received an incorrect diagnosis of sinus headache. Two studies found that over 50% of pediatric patients with migraines have associated cranial autonomic symptoms, possibly elucidating the reasons for misdiagnosis. Some case reports demonstrate successful treatment of rhinogenic contact point headache with the surgical resection of mucosal contact points, although this diagnosis continues to be debated. Many pediatric patients diagnosed with a sinus-related headache actually meet criteria for primary headache disorders. Primary headache disorders should be considered in pediatric patients with headache and associated rhinologic symptoms. Some literature suggests that mucosal contact point headaches can be surgically treated in children, but the level of evidence is inadequate, and additional robust trials are needed.
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Affiliation(s)
- Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Curtis Hanba
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter F Svider
- Hackensack University Medical Center, Hackensack, NJ, USA.
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Alexandersson C, Tuomi L, Olin AC. Measurement of Nasal Nitric Oxide in Chronic Rhinosinusitis and Its Relationship to Patient-Reported Outcome: A Longitudinal Pilot Study. EAR, NOSE & THROAT JOURNAL 2019; 100:522-529. [PMID: 31608679 DOI: 10.1177/0145561319880624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess whether nasal nitric oxide (nNO) levels differ between healthy and sick sinuses in chronic rhinosinusitis (CRS). A secondary aim was to assess whether nNO levels change after treatment of CRS and whether there is an association with radiological findings or symptoms. METHOD Three groups of 12 participants each were examined: patients with CRS without polyposis (CRS group), patients with symptoms of CRS but radiologically normal sinuses (symptoms-only), and healthy controls. Measurements of nNO were carried out using aspiration method and humming maneuver. All participants completed the Sino-Nasal Outcome Test (SNOT-22). A second nNO measurement was done after treatment in the CRS group (n = 9) and the healthy control group (n = 12). RESULTS Nasal NO did not differ between any of the groups with any of the measurement techniques. There was a trend toward lower nNO values in the CRS group compared with the symptoms-only group and healthy controls, but it did not reach statistical significance. The SNOT-22 demonstrated inferior values for the CRS and symptoms-only groups compared with the healthy controls. At follow-up, no statistically significant change was found for the nNO measurements in either group. CONCLUSION Irrespective of occluded or open ostiomeatal complexes, no statistically significant differences in nNO were found in CRS compared with healthy controls using aspiration and humming methods. Treatment of CRS improved sinus patency without accompanying a significant change in nNO. This study can therefore not conclude that nNO can be used as a diagnostic tool for CRS without polyposis.
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Affiliation(s)
- Cecilia Alexandersson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, 70712Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Cecilia Alexandersson and Lisa Tuomi contributed equally to this work
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, 70712Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Cecilia Alexandersson and Lisa Tuomi contributed equally to this work
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, 70712Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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CHIARUGI A, CAMAIONI A. Update on the pathophysiology and treatment of rhinogenic headache: focus on the ibuprofen/pseudoephedrine combination. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2019; 39:22-27. [PMID: 30936575 PMCID: PMC6444167 DOI: 10.14639/0392-100x-1882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022]
Abstract
Rhinogenic headache is frequently encountered in clinical practice. Treatment of this condition should be based on a proper evaluation of its underlying pathophysiology. Fixed-dose combinations of two or more active agents, and specifically the combination of ibuprofen plus pseudoephedrine, have been shown to be more efficacious than either monotherapy. At present, an ibuprofen/pseudoephedrine fixed-dose combination is available as an over-the-counter drug. This paper reviews in detail the pathophysiology of rhinogenic headache and discusses the rationale for treatment of this condition with a fixed-dose ibuprofen/pseudoephedrine combination.
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Affiliation(s)
- A. CHIARUGI
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Italy
| | - A. CAMAIONI
- Ear, Nose and Throat Department, San Giovanni Addolorata Hospital, Rome, Italy
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10
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Wu D, Gray ST, Holbrook EH, BuSaba NY, Bleier BS. SNOT-22 score patterns strongly negatively predict chronic rhinosinusitis in patients with headache. Int Forum Allergy Rhinol 2018; 9:9-15. [DOI: 10.1002/alr.22216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/24/2018] [Accepted: 09/01/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Dawei Wu
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Harvard Medical School; Boston MA
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing; People's Republic of China
| | - Stacey T. Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Harvard Medical School; Boston MA
| | - Eric H. Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Harvard Medical School; Boston MA
| | - Nicolas Y. BuSaba
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Harvard Medical School; Boston MA
| | - Benjamin S. Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Harvard Medical School; Boston MA
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Abstract
"Sinus headache" is a common chief complaint that often leads patients to an otolaryngologist's office. Because facial pain may or may not be sinogenic in origin, the otolaryngologist should be equipped to evaluate and treat or to appropriately refer these patients. Analysis of current data indicates that the majority of patients who present with sinus headaches actually have migraines. Furthermore, the downstream effect of the cytokine cascade initiated in migraine physiology can cause rhinologic symptoms, including rhinorrhea, congestion, and lacrimation, which may also confound diagnosis. Other causes of sinus headache include the following: cluster headaches, Sluder neuralgia, trigeminal neuralgia, myofascial trigger point pain (tension headaches, temporomandibular joint dysfunction), and contact point headaches. The diagnostic dilemma for an otolaryngologist occurs when a patient has facial pain and symptoms that may indicate chronic rhinosinusitis but with nondiagnostic endoscopy. Traditionally, these patients have been primarily managed with empiric antibiotics. An alternative strategy is to first screen these patients with an upfront computed tomography. This algorithm may ultimately decrease cost; avert unnecessary antibiotics prescriptions; and prompt more timely referrals to other, more appropriate, disciplines, such as neurology, dentistry, and/or pain management specialists.
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Affiliation(s)
- Asitha D L Jayawardena
- From the Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rakesh Chandra
- From the Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Kryukov AI, Tsarapkin GY, Tovmasyan AS, Arzamazov SG, Zaoeva ZO, Kishinevskii AE. [Differential diagnostics of headache associated with pathological changes in the nasal cavity and paranasal sinuses]. Vestn Otorinolaringol 2017; 82:39-43. [PMID: 28980595 DOI: 10.17116/otorino201782439-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Headache is not infrequently one of the major complaints in the patients visiting the otorhinolaryngologist's office. It was estimated to occur in 24% of the patients presenting with chronic sinusitis. The cause of headache may be pathological processes either in the nasal cavity or in the paranasal sinuses as well as a primary disorder in the nervous system. The present article is concerned with the peculiar features of rhinogenic headache and that of a different etiology. It was shown that the patients suffering from headache are in need not only of the obligatory otorhinolaryngological examination including endoscopy of the nasal cavity, X-ray study and, sometimes, specialized tests but also of neurological counseling. However, the surgical treatment does not always results in the elimination or relief of the rhinogenic headache. Hence, the importance of the evaluation of the risks and benefits of such treatment for an individual patient. The formation of the contact points in the nasal mucosa is considered to be one of the possible causes of rhinogenic headache. However, this opinion needs to be confirmed by the results of large-scale comparative clinical studies.
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Affiliation(s)
- A I Kryukov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152; Department of Otorhinolaryngology, Therapeutic Faculty, N.I. Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - G Yu Tsarapkin
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A S Tovmasyan
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - S G Arzamazov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - Z O Zaoeva
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A E Kishinevskii
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
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Abstract
Allergic rhinitis and migraine remain on the list of the most common diseases affecting adults. Migraines and headaches due to allergic rhinitis are easily confused because the symptoms of both conditions often overlap. Both may occur with sinus headache, nasal congestion, and lacrimation and may worsen with weather changes and exposure to allergens. No precise clinical definition exists for what constitutes a sinus headache, which has always been a diagnostic dilemma. Contrary to popular belief, headache is not a typical symptom of rhinitis. Some studies have shown that up to 90 % of sinus headaches are actually migraines. Nevertheless, patients with self-diagnosed sinus headache self-treat or are treated by primary care physicians and/or otolaryngologists with medications for rhinosinusitis, ignoring the neurogenic causes of the symptoms when most of these patients fulfill diagnostic criteria for chronic migraine. Chronic migraine affects 2 % of the general population and has a significant socioeconomic impact on society, incurring health care costs and diminishing quality of life; therefore, the proper diagnosis and treatment of these headache patients should be a priority.
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Affiliation(s)
- Anna Gryglas
- Department of Neurology, Gromkovski Voivodship Hospital, Department of Social Pediatrics, Wroclaw Medical University, Wroclaw, Poland.
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15
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Peric A, Rasic D, Grgurevic U. Surgical Treatment of Rhinogenic Contact Point Headache: An Experience from a Tertiary Care Hospital. Int Arch Otorhinolaryngol 2016; 20:166-71. [PMID: 27096023 PMCID: PMC4835330 DOI: 10.1055/s-0036-1578808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/06/2015] [Indexed: 10/24/2022] Open
Abstract
Introduction Even in the absence of inflammatory disease, facial pain often results from pressure of two opposing nasal mucosa surfaces. Objectives The objective of this study is to assess the efficacy of surgical treatment of contact point headache. Methods Our study enrolled patients with unilateral facial pain and without nasal/paranasal sinus disease. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography. Forty-two subjects with the three most common anatomical variations underwent complete evaluation: 17 with concha bullosa (CB), 11 with septal deviation (SD), and 14 with septal spur (SS). All participants were treated by topical corticosteroid, adrenomimetic, and antihistamine. The patients without improvement were treated surgically. We assessed the severity of pain using a Visual Analogue Score (VAS) before surgical treatment and one, six, twelve, and twenty-four months after. Results The patients with SS had more severe facial pain in comparison with patients with CB (p = 0.049) and SD (p = 0.000). The subjects with CB had higher degree of facial pain than the ones with SD (p = 0.001). After an unsuccessful medical treatment and surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with CB and SS (p = 0.000) than in the patients with SD (p = 0.01). Conclusion Our results suggest that topical medications have no effects and that surgical removal of mucosal contacts could be effective in the treatment of contact point headache. The results of surgical treatment were better in cases of facial pain caused by SS and CB, than in those caused by SD.
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Affiliation(s)
- Aleksandar Peric
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | - Dejan Rasic
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | - Ugljesa Grgurevic
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
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Herzallah IR, Hamed MA, Salem SM, Suurna MV. Mucosal contact points and paranasal sinus pneumatization: Does radiology predict headache causality? Laryngoscope 2015; 125:2021-6. [PMID: 25714919 DOI: 10.1002/lary.25194] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of this study was to evaluate the prevalence of mucosal contact points (MCP), concha bullosa (CB), and variable paranasal sinus (PNS) volumes among patients sent for rhinogenic headache workup as compared with controls. STUDY DESIGN Retrospective study with case and control groups. METHODS Fifty-three adults with clear PNS computed tomography (CT) scans were included: 28 patients who have originally undergone PNS CT scan as part of sinus (rhinogenic) headache workup, and 25 controls in whom PNS CT scans were obtained for other purposes. All subjects were asked to report their symptoms using a headache scoring system. CT scans of all subjects were analyzed for presence of MCP, CB, as well as for volumes of maxillary, frontal, and sphenoid sinuses. RESULTS MCP was found in 40% of controls, and in 50%, 50%, and 40% of mild, moderate, and severe headache groups, respectively. CB was found in 24% of controls, and in 33.3%, 58.3%, and 20%, of mild, moderate, and severe headache groups, respectively. Total volume of the measured PNS ranged from 23.9 to 81.4 cm(3) (mean ± standard deviation [SD], 48.3 ± 15.8) in the control group and from 5.31 to 87.4 cm(3) (mean ± SD, 43.6 ± 16) in the patient group. No statistically significant difference was found between groups regarding all studied variables. CONCLUSIONS Radiological identification of MCP, CB, or hyperpneumatized sinuses does not seem to be a predictor of headache causality. Further studies are required to identify clinical scenarios in which these variations may contribute to pain symptoms. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Islam R Herzallah
- Department of Otorhinolaryngology-Head and Neck Surgery, Zagazig, Egypt.,ENT Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Maged A Hamed
- Department of Radiology and Nuclear Medicine, Zagazig, Egypt
| | - Salem M Salem
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
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