Imaging for headache: what the neuroradiologist looks for

Headache Caused by Sinus Disease

Headaches and sinus disease are common reasons to seek medical care, with marked worldwide prevalence and large socioeconomic burdens. Headaches caused by sinus diseases are rare; many "rhinogenic headaches" are actually migraines. The similar symptoms may result from autonomic dysfunction and trigeminovascular pathways. Using the mnemonic ACHE, this article presents key Anatomy, Clinical cases, How to image, Essential clinical and radiographic features that help the radiologist, otolaryngologist, and neurologist evaluate sinus disease and headaches.

A comparative clinical and radiographic study on patients with chronic facial pain with and without temporomandibular disorder presenting to an otolaryngology clinic

Objective: Facial pain associated with temporomandibular disorder (TMD) is considered a component of Costen's syndrome. However, prior to the current study, no previous clinical and radiographic studies have addressed facial pain in patients with TMD. Methods: The study included 212 patients with chronic facial pain examined in an otolaryngology clinic. These were stratified into 132 patients with TMD and 80 patients without TMD. Clinical and radiographic findings were documented in both groups. Results: Forty-eight patients in the TMD group had normal endoscopic findings and clear CT scans and had their facial pain directly attributable to TMD. Conclusion: In patients presenting with facial pain, where nasal endoscopy reveals no abnormality, TMD should be specifically addressed, especially if CT scans of the paranasal sinuses are clear.

The role of the otolaryngologist in the evaluation and management of headaches

BACKGROUND

Headaches are commonly evaluated in otolaryngology and often represent a diagnostic dilemma. This review addresses rhinogenic headache as well as trigeminal neuralgia and migraine, both of which can masquerade as sinus headache and whose management increasingly involves otolaryngology intervention. Discussion considers diagnostic criteria and novel therapies and derives an algorithm for clinical decision-making.

DATA SOURCES

OVID MEDLINE, Cochrane Library, and Google Scholar databases.

METHODS

A literature search was performed to identify relevant articles published in the past 10 years addressing the diagnosis and management of rhinogenic headache, trigeminal neuralgia and/or migraine.

FINDINGS

Rhinogenic headache: Identification of the specific cause must be achieved before treatment. No studies have mentioned the effect of certain therapies on the amelioration of headache. New techniques of balloon dilation for sinusitis are controversial, and their use remains contingent on surgeon preference. Removal of mucosal contact points has been shown to benefit quality of life in patients with contact point headache. Trigeminal neuralgia: Microvascular decompression is considered the gold standard for treatment, but percutaneous therapies can be effective for achieving pain control. Migraine: Patients who report amelioration of symptoms after targeted botulinum toxin injection may benefit from definitive decompression or nerve avulsion. Patients with mucosal contact points may have less favorable outcomes with migraine surgery if they are not simultaneously addressed.

CONCLUSIONS

A comprehensive understanding of the diagnostic workup and therapeutic options available for common headache etiologies is key to the management of a patient presenting with headache attributed to a rhinogenic cause.

Imaging in Orofacial Pain

Imaging usefulness in the diagnosis of orofacial pain includes all modalities that cover the soft tissue and bony structures in the region of the head and neck. Imaging techniques may include 2-dimensional and/or 3-dimensional imaging modalities. Both dentists and physicians should be aware of orofacial pain associated with a variety of sources and select the appropriate imaging technique based on the patient's medical and dental history and the clinical examination. The goal of imaging is to provide the clinician with information that will confirm or deny findings of the clinical examination and allow for the selection of an appropriate treatment.