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Campbell JC, Canick JE, Chen PG, Hachem RA, Jang DW. Barosinusitis due to routine weather changes: A cross-sectional analysis of public websites. World J Otorhinolaryngol Head Neck Surg 2024; 10:18-23. [PMID: 38560031 PMCID: PMC10979036 DOI: 10.1002/wjo2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 04/04/2024] Open
Abstract
Background Sinusitis is a common diagnosis that can be erroneously associated with routine weather-related barometric pressure changes. In actuality, these pressure changes likely exacerbate migraine headaches, which can cause facial pain and pressure rather than true sinus inflammation. Objective The present study sought to characterize the representation of both sinusitis and migraine in association with barometric pressure changes across websites on the Internet. Methods An Internet search for relevant terms was conducted, and content of the resulting pages was assessed for associations between weather-related pressure changes and either sinusitis or migraine. Variations in reported results across different subtypes of Internet sources were analyzed. The primary outcomes measured were (1) whether a given media source associated barometric weather changes with sinusitis, (2) whether that source associated barometric weather changes with migraine, and (3) treatment options offered by that source. Results Of the 116 included webpages, 36 (31.03%) associated sinusitis and routine barometric pressure changes. Of these, 10 (27.77%) were otolaryngology practice sites. Sixty-seven webpages (57.76%) associated migraine and routine barometric pressure changes. Of these, nonotolaryngology webpages were more likely to report this link. Conclusions Otolaryngology practice sites were observed to be the most frequent professional medical resource reporting the unsubstantiated claim that routine barometric pressure changes are associated with sinusitis. Nonotolaryngology sources were more likely to link weather-related pressure changes to migraine. These results suggest that opportunities exist for otolaryngology practice sites to educate patients about nonrhinogenic headache etiologies.
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Affiliation(s)
- James C. Campbell
- Department of Head and Neck Surgery & Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | | | - Philip G. Chen
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Texas Health Science Center San AntonioSan AntonioTexasUSA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - David W. Jang
- Department of Head and Neck Surgery & Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
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2
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Zakaria OM, Alsaleh MA. Problem of headache: A cross-sectional study. J Family Med Prim Care 2023; 12:1361-1366. [PMID: 37649766 PMCID: PMC10465060 DOI: 10.4103/jfmpc.jfmpc_2301_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives To assess the medical students, interns, general practitioners, and family physicians' perception of neurological and otolaryngeal causes of headaches. Materials and Methods A prospective, qualitative, questionnaire-based cross-sectional study took place. Five hundred and seventy-one senior medical students, interns, general practitioners (GPs), and family physicians from different geographical regions in Saudi Arabia were involved in the study. An online questionnaire is used to estimate the respondents' knowledge regarding neurological and otolaryngeal causes of headaches. The obtained data were statistically analyzed using SPSS version 21. Results Five hundred and seventy-one participants were involved in the study. They were 377 females and 194 males with a female-to-male ratio of 1.9:1. Most of them were medical students (69.9%). However, medical interns, general practitioners, and family physicians' respondents were (17.3%), (7.5%), and (5.3%), respectively. They constituted different geographical regions of Saudi Arabia. An average level of knowledge about headaches was recorded in (55%) of the participants, while (42.7%) had a good level of knowledge about its etiologies. Conclusions A considerable percentage of the current study population has average knowledge about neurological and otolaryngeal factors of headache. It is advocated that the current national medical curriculum be thoroughly reviewed and clear referral pathways must be established to have better management of these cases.
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Affiliation(s)
- Ossama M. Zakaria
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Eastern Province, Saudi Arabia
| | - Majd A. Alsaleh
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Eastern Province, Saudi Arabia
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3
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Ferretti A, Gatto M, Velardi M, Di Nardo G, Foiadelli T, Terrin G, Cecili M, Raucci U, Valeriani M, Parisi P. Migraine, Allergy, and Histamine: Is There a Link? J Clin Med 2023; 12:jcm12103566. [PMID: 37240671 DOI: 10.3390/jcm12103566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The relationship between migraines and allergies is controversial. Though they are epidemiologically linked, the underlying pathophysiological connection between them remains unclear. Migraines and allergic disorders have various underlying genetic and biological causes. As per the literature, these conditions are epidemiologically linked, and some common pathophysiological pathways have been hypothesized. The histaminergic system may be the clue to understanding the correlation among these diseases. As a neurotransmitter in the central nervous system with a vasodilatory effect, histamine has a well-documented influence on the allergic response and could be involved in the pathophysiology of migraines. Histamine may influence hypothalamic activity, which may play a major role in migraines or may simply influence their severity. In both cases, antihistamine drugs could prove useful. This review examines whether the histaminergic system, particularly H3 and H4 receptors, may provide a mechanistic link between the pathophysiology of migraines and allergic disorders, two common and debilitating conditions. Identifying their connection could help identify novel therapeutic strategies.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Mattia Gatto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Margherita Velardi
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Giovanni Di Nardo
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianluca Terrin
- Department of Mother and Child, Gynecological and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00185 Rome, Italy
| | - Manuela Cecili
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
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Tang SJ, Lee H, Cui T, Lee JM, Ahn JY, Lee S, Kim S. A Comparison of Clinical Features of Youth with and without Rhinitis Signs and Symptoms Who Are Hospitalized for Headache. CHILDREN 2022; 9:children9081241. [PMID: 36010131 PMCID: PMC9406595 DOI: 10.3390/children9081241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
Headache and allergic rhinitis (AR) are common in children and often co-occur. We investigated the clinical characteristics of pediatric headaches and the association of AR and chronic headaches. We retrospectively reviewed the medical records of patients admitted to our pediatric inpatient and outpatient clinics with complaints of headache between January 2017 and June 2020 for headache-specific history, AR signs and symptoms, allergy skin prick test, inhalant multiple allergen simultaneous test results, laboratory and imaging findings, and medication history. The patients were divided into three subgroups: AR, non-AR, and headache groups, reporting 45.7% patients with headache alone, 13.7% with additional AR, and 31.6% with abnormal imaging findings, suggesting that headache was combined with sinusitis (24.3%) or mastoiditis (7.3%). Furthermore, 6% of the patients had both AR and sinusitis. Body mass index (BMI) differed significantly between the AR and the non-AR and headache groups (p = 0.03). The BMI differed significantly according to headache severity (p ˂ 0.001). The most common allergen was “dust or mites” (41.1%). Acetaminophen (35.9%) was the most commonly used painkiller. The coexistence of AR and headache may indicate that these conditions share a similar pathophysiology. Better management of allergies may facilitate diagnosis, treatment, and prophylaxis of headaches.
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Affiliation(s)
- Si-Jia Tang
- Graduate School, Yeungnam University College of Medicine, Daegu 42415, Korea
| | - Heejin Lee
- Department of Pediatrics, Yeungnam University Medical Center, Daegu 42415, Korea
| | - Tiantian Cui
- Graduate School, Yeungnam University College of Medicine, Daegu 42415, Korea
| | - Jae Min Lee
- Department of Pediatrics, Yeungnam University Medical Center, Daegu 42415, Korea
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu 42415, Korea
| | - Ji Young Ahn
- Department of Pediatrics, Yeungnam University Medical Center, Daegu 42415, Korea
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu 42415, Korea
| | - Sua Lee
- Department of Pediatrics, Yeungnam University Medical Center, Daegu 42415, Korea
| | - Saeyoon Kim
- Department of Pediatrics, Yeungnam University Medical Center, Daegu 42415, Korea
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu 42415, Korea
- Correspondence:
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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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Abstract
PURPOSE OF REVIEW Although sinus headache has been extensively reviewed and described, misdiagnosis remains common. This paper discusses the myths and truths about sinus headaches. RECENT FINDINGS Sinus headache is used colloquially to attribute facial pain to allergies or a sinus infection; however, most sinus headaches are migraine. Sinus-region pain from sinusitis and migraine share the same origins in the trigeminovascular system, but their causes are very different. After reviewing sinus anatomy and sinogenic pain, we provide information to assist clinicians in correctly diagnosing patients with the additional goal of avoiding unnecessary investigations and treatments. Migraine medications can be used as both a treatment and a diagnostic tool. Other differential diagnoses of facial pain are discussed. Sinus headache is not a diagnosis. All patients with facial pain or pressure with sinus symptoms should be evaluated for migraine because most sinus headache presentations are migraine and require migraine-directed treatment.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Barrow Neurological Institute c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA.
| | - Karissa A Secora
- Department of Neurology, Barrow Neurological Institute c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA
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9
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Koch M, Sertel-Nakajima J, Messlinger K. Responses of spinal trigeminal neurons to noxious stimulation of paranasal cavities - a rat model of rhinosinusitis headache. Cephalalgia 2020; 41:535-545. [PMID: 33203222 DOI: 10.1177/0333102420970467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pathophysiology of headaches associated with rhinosinusitis is poorly known. Since the generation of headaches is thought to be linked to the activation of intracranial afferents, we used an animal model to characterise spinal trigeminal neurons with nociceptive input from the dura mater and paranasal sinuses. METHODS In isoflurane anaesthetised rats, extracellular recordings were made from neurons in the spinal trigeminal nucleus with afferent input from the exposed frontal dura mater. Dural and facial receptive fields were mapped and the paranasal cavities below the thinned nasal bone were stimulated by sequential application of synthetic interstitial fluid, 40 mM potassium chloride, 100 µM bradykinin, 1% ethanol (vehicle) and 100 µm capsaicin. RESULTS Twenty-five neurons with input from the frontal dura mater and responses to chemical stimulation of the paranasal cavities were identified. Some of these neurons had additional receptive fields in the parietal dura, most of them in the face. The administration of synthetic interstitial fluid, potassium chloride and ethanol was not followed by significant changes in activity, but bradykinin provoked a cluster of action potentials in 20 and capsaicin in 23 neurons. CONCLUSION Specific spinal trigeminal neurons with afferent input from the cranial dura mater respond to stimulation of paranasal cavities with noxious agents like bradykinin and capsaicin. This pattern of activation may be due to convergent input of trigeminal afferents that innervate dura mater and nasal cavities and project to spinal trigeminal neurons, which could explain the genesis of headaches due to disorders of paranasal sinuses.
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Affiliation(s)
- Michael Koch
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Julika Sertel-Nakajima
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Goyal VK, Ahmad A, Turfe Z, Peterson EI, Craig JR. Predicting Odontogenic Sinusitis in Unilateral Sinus Disease: A Prospective, Multivariate Analysis. Am J Rhinol Allergy 2020; 35:164-171. [PMID: 32646233 DOI: 10.1177/1945892420941702] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) is a common cause of unilateral sinus disease (USD), but can be challenging to diagnose due to nonspecific clinical presentations, potentially subtle to absent dental pathology on sinus computed tomography (CT), and underrepresentation in the sinusitis literature. OBJECTIVE Identify sinonasal clinical variables predictive of ODS in patients presenting with unilateral maxillary sinus opacification on sinus CT. METHODS A prospective cohort study was conducted on 131 consecutive patients with USD and at least partial or complete maxillary sinus opacification on sinus CT. Patients' demographics, sinonasal symptoms (anterior and posterior drainage, nasal obstruction, facial pressure, smell loss, and foul smell), 22-item sinonasal outcome test, nasal endoscopy findings, CT findings, and histopathology were collected. Patients' diagnoses included ODS, chronic rhinosinusitis with or without nasal polyps, and inverted papilloma. Demographic and clinical data were compared between patients with unilateral ODS and non-odontogenic disease using univariate and multivariate analyses. RESULTS Of the 131 USD patients, 65 had ODS and 66 had non-odontogenic disease. The following variables were significantly associated with unilateral ODS on multivariate analysis: middle meatal pus on endoscopy (OR= 17.67, 95% CI-5.69, 54.87; p = 0.001), foul smell (OR= 6.11, 95% CI-1.64, 22.82; p=.007), facial pressure (OR= 3.55, 95% CI-1.25, 10.12; p = 0.018), and any frontal opacification on CT (OR= 5.19, 95% CI-1.68, 16.06; p = 0.004). Any sphenoid opacification on CT was inversely related to ODS (OR = 0.14, 95% CI-0.03, 0.69; p = 0.016). The study was adequately powered. CONCLUSION With unilateral maxillary sinus disease, the following features were significantly associated with ODS: foul smell, ipsilateral facial pressure, middle meatal pus on endoscopy, and any frontal sinus opacification on sinus CT. Additionally, any sphenoid sinus opacification on CT was inversely related to ODS. Presence or absence of these clinical variables can be used to increase or decrease one's suspicion of an odontogenic source of sinusitis.
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Affiliation(s)
- Vinay K Goyal
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - Abid Ahmad
- Wayne State Medical University, Detroit, Michigan
| | - Zaahir Turfe
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - Edward I Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, Michigan
| | - John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
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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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Maurya A, Qureshi S, Jadia S, Maurya M. "Sinus Headache": Diagnosis and Dilemma?? An Analytical and Prospective Study. Indian J Otolaryngol Head Neck Surg 2019; 71:367-370. [PMID: 31559205 PMCID: PMC6737117 DOI: 10.1007/s12070-019-01603-3] [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] [Received: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022] Open
Abstract
To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.
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Affiliation(s)
- Ashish Maurya
- Department of E.N.T, Government Medical College, Datia, MP India
| | - Sadat Qureshi
- Department of E.N.T, Peoples Medical College and Research Centre, Bhopal, India
| | - Shalini Jadia
- Department of E.N.T, Peoples Medical College and Research Centre, Bhopal, India
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Abstract
PURPOSE OF REVIEW This article is intended to assist clinicians in distinguishing benign primary headache syndromes from serious headache presentations that arise from exogenous causes. RECENT FINDINGS Although most cases of severe headache are benign, it is essential to recognize the signs and symptoms of potentially life-threatening conditions. Patients with primary headache disorders can also acquire secondary conditions that may present as a change in their baseline headache patterns and characteristics. Clinical clues in the history and examination can help guide the diagnosis and management of secondary headache disorders. Furthermore, advances in the understanding of basic mechanisms of headache may offer insight into the proposed pathophysiology of secondary headaches. SUMMARY Several structural, vascular, infectious, inflammatory, and traumatic causes of headache are highlighted. Careful history taking and examination can enable prompt identification and treatment of underlying serious medical disorders causing secondary headache syndromes.
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Paranasal sinus volumes and headache: is there a relation? Eur Arch Otorhinolaryngol 2019; 276:2267-2271. [PMID: 31098874 DOI: 10.1007/s00405-019-05461-1] [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] [Received: 02/17/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study is to investigate the relation between paranasal sinus volumes and headache in patients with no other rhinologic causes. METHODS Two hundred patients with chronic headache and 99 subjects with no headache or facial pain history in the last 6 months were included in the study. Paranasal computed tomography (CT) scans of both patient and control groups were evaluated. Sixty one patients were excluded from the study due to possible rhinogenic headache CT findings such as secretions and contact points. Sinus volume index (SVI) formula created by Barghouth et al. in 2002 was used to calculate paranasal sinus volumes: SVI = ½. A × B × C. Mann-Whitney U test was used to compare an independent continuous variable and a continuous variable with non-normal distribution. RESULTS In the patient group, the total sinus, frontal sinus, and maxillary sinus volumes were found to be significantly lower than those of the control group (p < 0.001). Although the total sphenoid sinus volume was found to be lower in the patient group, there was no significant difference between the two groups (p = 0.013). CONCLUSION Although rhinogenic findings are often related to secondary headache, the relation between paranasal sinus volume and headache is scarcely investigated in the literature. Our study showed that paranasal sinus volumes might have a role in secondary headaches. Furthermore, in contrast to the literature, our study showed a significant relation between headache and smaller paranasal sinus volumes.
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Update on the diagnostic considerations for neurogenic nasal and sinus symptoms: A current review suggests adding a possible diagnosis of migraine. Am J Otolaryngol 2019; 40:306-311. [PMID: 30473169 DOI: 10.1016/j.amjoto.2018.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Treatment of rhinosinusitis (RS) is one of the leading reasons for prescriptions of antibiotics, although they often fail to provide symptomatic relief. Appropriately diagnosing and treating patients presenting with RS for whom antibiotic therapy has failed or who have normal CT findings is a controversial topic. One explanation is that what these patients are experiencing is misinformation from the trigeminal nerve and autonomic nervous system. Midfacial pain and pressure with rhinorrhea and nasal congestion do not represent an infectious, or even inflammatory, condition within the sinus or nasal cavities, but a mirage that is best treated as a migraine variant. Observations Although there is not enough research to definitively prove this alternate etiology, we are reaching a tipping point where the clinical implications, real-world experience, and evolving literature support this possible alternate etiology. Four key factors support a midfacial migraine that mimics RS: 1) Pathophysiology: current pathophysiology literature offers a model of how migraine attacks could replicate clinical presentations of RS; 2) Clinical presentation: patients with infectious RS and midfacial migraine have similar symptomatic presentation, similar demographics, but poorly correlated radiological information; 3) Diagnosis: clinical studies support the proposition that there are alternative diagnostic tools for distinguishing patients with midfacial migraine; and 4) Prognosis: Select RS patients show significant improvement with migraine treatment. CONCLUSIONS We encourage medical professionals to consider migraine disease as a form of sensory misinformation and as a possible etiology of RS complaints. Clinicians can ask validated questions to determine if possible migraine could be an underlying cause, and there are standard preventative treatments for migraine that could alleviate patient symptoms. Dysfunctional vasomotor activity may be the root of the disturbances, particularly when antibiotic therapy fails and CT findings are discordant with symptoms. Until there is a diagnostic test for migraine, clinicians need to question a patient's self-diagnosis of rhinosinusitis. More research is needed to definitively answer this important question.
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Hu S, Helman S, Filip P, Cabin J, Colley P. The role of the otolaryngologist in the evaluation and management of headaches. Am J Otolaryngol 2019; 40:115-120. [PMID: 30523783 DOI: 10.1016/j.amjoto.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/05/2018] [Indexed: 01/03/2023]
Abstract
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.
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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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Schulz KA, Esmati E, Godley FA, Hill CL, Monfared A, Teixido M, Tucci DL, Witsell DL. Patterns of Migraine Disease in Otolaryngology: A CHEER Network Study. Otolaryngol Head Neck Surg 2018; 159:42-50. [DOI: 10.1177/0194599818764387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective To evaluate the prevalence of migraine disease in an otolaryngologic cohort and migraine-related otologic and sinonasal symptoms in this population. Study Design Cross-sectional study utilizing the CHEER (Creating Healthcare Excellence through Education and Research) network for recruitment. Setting Patients were recruited in a cross-sectional and pragmatic manner in 14 CHEER sites between June 2015 and March 2017 (9 academic, 5 community based). Subjects and Methods Patients were included if they were aged ≥18 years and seen for any concern that was not head and neck cancer. Patients with any history of brain abnormality or headaches that began within 2 weeks of a medical illness, trauma, or head injury were excluded. Patients were screened for migraine with a validated instrument. If they screened positive on the Migraine Assessment Tool (MAT+), the subjects also filled out validated and custom questionnaires for sinonasal, otologic, and migraine-specific symptoms. Results Of 1458 patients screened, 235 (16.1%) screened positive for migraine (MAT+), which is higher than general population (13%, P < .001). The MAT+ group was significantly younger (47.2 vs 55.6 years of age, P < .001) and predominantly women (80.0% vs 55.9%, P < .001). The MAT+ cohort commonly reported ear- and sinus-related symptoms, such as tinnitus (70.5%), ear pressure (61.9%), balance problems (82%), facial pressure (85%), and rhinorrhea (49.9%). There were significantly higher levels of sinus burden with higher levels of dizziness handicap, Jonckheere-Terpstra test = 11,573.00, z = 7.471, P < .001. Conclusion Migraine disease has a higher prevalence in an otolaryngologic cohort than in the general population, presenting with a high rate of sinonasal and otologic symptoms that may be due to or exacerbated by migraines.
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Affiliation(s)
- Kristine A. Schulz
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Elnaz Esmati
- Department of Otolaryngology, George Washington University, Washington, DC, USA
| | | | - Claude L. Hill
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ashkan Monfared
- Department of Otolaryngology, George Washington University, Washington, DC, USA
| | - Michael Teixido
- Association of Migraine Disorders, North Kingstown, Rhode Island, USA
| | - Debara L. Tucci
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - David L. Witsell
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Vieira Neto RJ, Teixeira KCS, Guerreiro MM, Montenegro MA. Paranasal Sinus Disease in Children With Headache. J Child Neurol 2017; 32:1014-1017. [PMID: 28831857 DOI: 10.1177/0883073817724696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sinus headache is one of the most frequent misdiagnosis given to children with headache. The objective of this study is to evaluate the frequency of sinus disease in children with headache that do not fulfill the criteria for headache attributed to disorder of the nose or paranasal sinuses. METHODS This is a prospective study conducted at the authors' pediatric neurology clinic. Data from children with headache was evaluated and compared with a disease control group composed of children without history of headache. All patients underwent neuroimaging assessment. Patients with diagnosis of acute infectious sinus disease were excluded from the analysis. The type of headache was classified according to the International Headache Society. Statistical analysis was performed using the Fisher exact test, with a level of significance of .05. RESULTS A total of 62 patients with headache were evaluated; 24 boys, 38 girls, ages ranging from 3 to 18 years (mean = 9.7 years). Of the patients, 29 had migraine without aura, 4 had frequent episodic tension type headache, 3 had both migraine without aura and frequent episodic tension type headache, 3 had migraine with brainstem aura, 2 had episodic tension type headache, 1 had migraine with aura. In 20 patients the type of headache could not be established. The disease control group had 41 patients; 25 boys, 16 girls, ages ranging from 3 to 17 years (mean = 7.3 years). Sinus abnormalities detected by neuroimaging were present in 12 patients in the headache group and in 11 patients in the disease control group ( P = .469). CONCLUSION The authors conclude that sinus abnormalities are a common finding in neuroimaging tests of children with or without headache. Sinus disease disclosed by neuroimaging evaluation should not preclude the diagnosis of migraine or other types of primary headache.
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Affiliation(s)
- Ronan J Vieira Neto
- 1 Child Neurology Unit, Department of Neurology, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Karine C S Teixeira
- 1 Child Neurology Unit, Department of Neurology, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Marilisa M Guerreiro
- 1 Child Neurology Unit, Department of Neurology, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Maria Augusta Montenegro
- 1 Child Neurology Unit, Department of Neurology, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
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Muehlberger T, Wormald JCR, Hachach-Haram N, Mosahebi A. Migraine: A look down the nose. J Plast Reconstr Aesthet Surg 2017; 70:914-921. [PMID: 28359726 DOI: 10.1016/j.bjps.2017.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have suggested that contact between opposing mucosal surfaces in the nasal wall and cavity can be a target of the surgical treatment of migraines. Unfortunately, not enough is known about the role of nasal pathology in the pathogenesis of this condition. The co-existence of further rhinological disorders can be an impediment to defining the cause and effect of anatomical variants. The authors compared the MRI scans of migraine- and non-migraine patients (MPs and NMPs, respectively) to determine the prevalence of such mucosal contact points in order to extrapolate whether there is a significant association with migraines. METHODS Coronal and axial MRI brain scans of 522 patients (412 migraineurs and 110 non-migraineurs) were analysed for the prevalence of anatomical variations of the nasal cavity, e.g. concha bullosa, septal deviations, mucosal swelling and contact points. RESULTS The results showed no significant difference between MPs and NMPs patients for any of the parameters examined. Moreover, 87% MPs and 79% NMPs had at least one contact point. The most frequent contact point was between the middle turbinate and the septum, observed in 54% of MPs and 45% of NMPs. CONCLUSIONS Contact points with the nasal mucosa are highly prevalent in both MPs and NMPs. Although a contact point does not cause a migraine in the absence of the disease, the concomitant presence of migraine and contact points can trigger an attack, and therefore, it is necessary to differentiate or exclude a rhinological disorder in these patients.
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Affiliation(s)
- Thomas Muehlberger
- Migraine Surgery Centre, 10 Harley Street, London W1G 9PF, United Kingdom.
| | - Justin C R Wormald
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital NHS Trust, Pond Street, London NW3 2QG, United Kingdom
| | - Nadine Hachach-Haram
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital NHS Trust, Pond Street, London NW3 2QG, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital NHS Trust, Pond Street, London NW3 2QG, United Kingdom
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Diverse Physiological Roles of Calcitonin Gene-Related Peptide in Migraine Pathology: Modulation of Neuronal-Glial-Immune Cells to Promote Peripheral and Central Sensitization. Curr Pain Headache Rep 2017; 20:48. [PMID: 27334137 DOI: 10.1007/s11916-016-0578-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The neuropeptide calcitonin gene-related peptide (CGRP) is implicated in the underlying pathology of migraine by promoting the development of a sensitized state of primary and secondary nociceptive neurons. The ability of CGRP to initiate and maintain peripheral and central sensitization is mediated by modulation of neuronal, glial, and immune cells in the trigeminal nociceptive signaling pathway. There is accumulating evidence to support a key role of CGRP in promoting cross excitation within the trigeminal ganglion that may help to explain the high co-morbidity of migraine with rhinosinusitis and temporomandibular joint disorder. In addition, there is emerging evidence that CGRP facilitates and sustains a hyperresponsive neuronal state in migraineurs mediated by reported risk factors such as stress and anxiety. In this review, the significant role of CGRP as a modulator of the trigeminal system will be discussed to provide a better understanding of the underlying pathology associated with the migraine phenotype.
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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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24
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Wang IC, Tsai JD, Lin CL, Shen TC, Li TC, Wei CC. Allergic rhinitis and associated risk of migraine among children: a nationwide population-based cohort study. Int Forum Allergy Rhinol 2015; 6:322-7. [PMID: 26446370 DOI: 10.1002/alr.21654] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/09/2015] [Accepted: 08/26/2015] [Indexed: 02/03/2023]
Affiliation(s)
- I-Chung Wang
- Children's Hospital; China Medical University Hospital; Taichung Taiwan
| | - Jeng-Dau Tsai
- Department of Pediatrics; Chung Shan Medical University Hospital; Taichung Taiwan
- Institute of Medicine; Chung Shan Medical University; Taichung Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Institute of Biostatistics; China Medical University; Taichung Taiwan
| | - Te-Chun Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Tsai-Chung Li
- Institute of Biostatistics; China Medical University; Taichung Taiwan
| | - Chang-Ching Wei
- Children's Hospital; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
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Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152:S1-S39. [PMID: 25832968 DOI: 10.1177/0194599815572097] [Citation(s) in RCA: 495] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This update of a 2007 guideline from the American Academy of Otolaryngology--Head and Neck Surgery Foundation provides evidence-based recommendations to manage adult rhinosinusitis, defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. Changes from the prior guideline include a consumer added to the update group, evidence from 42 new systematic reviews, enhanced information on patient education and counseling, a new algorithm to clarify action statement relationships, expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy of acute bacterial rhinosinusitis (ABRS), and 3 new recommendations for managing chronic rhinosinusitis (CRS). PURPOSE The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult rhinosinusitis and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy for adult rhinosinusitis, promote appropriate use of ancillary tests to confirm diagnosis and guide management, and promote judicious use of systemic and topical therapy, which includes radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. ACTION STATEMENTS The update group made strong recommendations that clinicians (1) should distinguish presumed ABRS from acute rhinosinusitis (ARS) caused by viral upper respiratory infections and noninfectious conditions and (2) should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days (if a decision is made to treat ABRS with an antibiotic); (3) should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; (4) should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms; (5) should assess the patient with CRS or recurrent ARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia; (6) should confirm the presence or absence of nasal polyps in a patient with CRS; and (7) should recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS. The update group stated as options that clinicians may (1) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis; (2) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation) for symptomatic relief of ABRS; and (3) obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent ARS. The update group made recommendations that clinicians (1) should not obtain radiographic imaging for patients who meet diagnostic criteria for ARS, unless a complication or alternative diagnosis is suspected, and (2) should not prescribe topical or systemic antifungal therapy for patients with CRS.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, School of Medicine, St Louis, Missouri, USA
| | | | - Itzhak Brook
- Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Kaparaboyna Ashok Kumar
- Department of Family Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Maggie Kramper
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Richard R Orlandi
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James N Palmer
- Department Otolaryngology, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology Head & Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Anju Peters
- Department of Internal Medicine, Northwestern University Allergy Division, Chicago, Illinois, USA
| | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Davis, California, USA
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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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Wee JH, Lee JE, Hong SL, Shin JM, Kim DY. Prospective Study on the Characteristics and Postoperative Improvement of Rhinogenic Headache. JOURNAL OF RHINOLOGY 2015. [DOI: 10.18787/jr.2015.22.1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jee Hye Wee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Eun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwang-ju, Korea
| | - Sung-Lyong Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University College of Medicine, Pusan, Korea
| | - Jae Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Dong-Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Research Center for Sensory Organs, Seoul National University College of Medicine, Seoul, Korea
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Sanges G, Gamerra M, Sorrentino G, De Luca R, Merone M, Feleppa M, Bigal ME. Endoscopic sinus surgery in individuals with facial pain due to chronic maxillary sinusitis - a functional controlled study. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:609-12. [PMID: 25003399 DOI: 10.1590/0004-282x20140092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To measure the intra-sinus pressure and the maxillary sinus functional efficiency (MSFE) in individuals with chronic facial pain after conservative or conventional endoscopic maxillary surgery, as well as in controls. METHOD Sinus manometry was performed 5 times during inhalation. RESULTS The resemblance of pressure values comparing those treated with minimally invasive surgery and controls was remarkable, while traditional surgery significantly decreased intrasinusal pressures. The MSFE was 100% in the three tested times for controls, close to that in those submitted to minimally invasive surgery (98.3%, 98.8%, and 98.0%) and significantly impaired after conventional surgery (48.8%, 52.1%, 48.5 %, p<0.01). All patients submitted to minimally invasive surgery remained pain-free after three months of surgery, relative to 46.7% of the submitted to conventional surgery (p<0.05). CONCLUSION Minimally invasive sinus surgery is associated with functionality of the chambers that resemble what is found in normal individuals.
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Affiliation(s)
- Giuseppe Sanges
- Headache and Cervico-Facial Pain Service, A.S.L. NA 3, Naples, Italy
| | - Mario Gamerra
- Surgery Department, ?S. Leonardo Hospital?, A.S.L. NA 3, Castellammare di Stabia, Naples, Italy
| | - Gerardo Sorrentino
- Surgery Department, ?S. Leonardo Hospital?, A.S.L. NA 3, Castellammare di Stabia, Naples, Italy
| | - Roberto De Luca
- Department of Physics ?E. R. Caianiello?, University of Salerno, Italy
| | | | - Michele Feleppa
- Department of Neurology, Hospital ?G. Rummo?, Benevento, Italy
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Patel ZM, Setzen M, Poetker DM, DelGaudio JM. Evaluation and Management of “Sinus Headache” in the Otolaryngology Practice. Otolaryngol Clin North Am 2014; 47:269-87. [DOI: 10.1016/j.otc.2013.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Nellis JC, Payne SC. Paroxysmal autonomic dysfunction in a patient with chronic rhinosinusitis. Otolaryngol Head Neck Surg 2013; 150:157-9. [PMID: 24132043 DOI: 10.1177/0194599813509060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jason C Nellis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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Friedman DI. Secondary Headache Disorders Encountered in Clinical Practice. Headache 2013. [DOI: 10.1002/9781118678961.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bernstein JA, Fox RW, Martin VT, Lockey RF. Headache and facial pain: differential diagnosis and treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:242-51. [PMID: 24565480 DOI: 10.1016/j.jaip.2013.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 11/16/2022]
Abstract
Headaches affect 90% of the population sometime during their life. Most are benign and fleeting, some are serious and life-threatening, and others require ongoing medical consultation and treatment. A careful history and physical is necessary to establish a differential diagnosis and to guide the choice of testing to make an accurate diagnosis. The most common types of headaches are discussed in this review. They are divided into primary and secondary headache disorders as classified by the International Headache Society. Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Secondary headaches are those that occur as a result of some other disorder and include brain tumors, rhinosinusitis, diseases of intracranial and extracranial vasculature, and temporomandibular joint disease.
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Affiliation(s)
- Jonathan A Bernstein
- Professor of Medicine, Director of Clinical Research, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Roger W Fox
- Professor of Medicine, Pediatrics and Public Health, Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Vincent T Martin
- Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati, Cincinnati, Ohio; Associate Editor for Headache, American Headache Society, Mount Royal, NJ
| | - Richard F Lockey
- Distinguished University Health Professor, Professor of Medicine, Pediatrics and Public Health, Director, Division of Allergy and Immunology, Joy McCann Culverhouse Chair in Allergy and Immunology, Morsani University of South Florida College of Medicine, Tampa, Fla.
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33
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Endoscopic management of contact point headache in patients resistant to medical treatment. Indian J Otolaryngol Head Neck Surg 2013; 65:415-20. [PMID: 24427689 DOI: 10.1007/s12070-013-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 02/09/2013] [Indexed: 10/27/2022] Open
Abstract
The existence and the best treatment for contact point headache is a controversial issue. Therefore, this study tried to evaluate the response of the patients with a rhinogenic headache who were resistant to medical treatment to endoscopic sinus surgery. Thirty patients who suffered from a unilateral headache or facial ache for at least 1 year and resistant to medical treatment were evaluated in this research. The existence of the contact point was confirmed in CT scan and in nasal endoscopy. Moreover, a positive Lidocaine test was another important factor for selecting patients. Endoscopic surgery was the common method of surgery in patients. After 1 year, the headache and nasal obstruction were assessed according to Visual Analogue Scale (VAS) and compared to preoperative VAS. In 30 patients who entered this research, the average headache and nasal obstruction score according to VAS was 7.4 ± 1.4 and 7.9 ± 2.5, respectively. These values consequently decreased to 4.8 ± 2.3 and 3.73 ± 1.7 1 year after surgery, respectively. The overall response rate was 93.3 % and no major complications were seen in this series. If there is strong clinical suspicion and meticulous selection criteria, provided that other causes of headache have been ruled out, endoscopic management of the rhinogenic headache can be effective.
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Patel ZM, Kennedy DW, Setzen M, Poetker DM, DelGaudio JM. "Sinus headache": rhinogenic headache or migraine? An evidence-based guide to diagnosis and treatment. Int Forum Allergy Rhinol 2012; 3:221-30. [PMID: 23129234 DOI: 10.1002/alr.21095] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 06/18/2012] [Accepted: 06/26/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients present to physicians across multiple disciplines with the complaint of sinus headache. This lay term is widely accepted in the media, yet has been repeatedly questioned in the medical literature, and experts in the fields of otolaryngology, neurology, and allergy have agreed that it is an overused and often incorrect diagnosis in the majority of patients. There have been review articles and consensus panels established regarding this issue, but thus far no guidelines based purely on a review of the level of evidence provided by the literature. METHODS A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old, self-diagnosed or physician-diagnosed "sinus headache," clearly defined diagnostic criteria in diagnostic studies, and clearly defined primary clinical end-point in therapeutic studies. RESULTS We identified and evaluated the literature on diagnosing and treating patients with a primary complaint of sinus headache. The literature was reviewed for both quality of research design as well as benefit and harm of the proposed interventions. CONCLUSION If a thorough neurologic and otolaryngologic evaluation is performed, the majority of patients presenting with sinus headache in the absence of significant acute inflammatory findings will be diagnosed with migraine. In this situation, the appropriate treatment for the majority of patients presenting with sinus headache is migraine directed therapy. In a highly select group of patients, directed nasal surgery addressing endonasal contact points may be an option.
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Affiliation(s)
- Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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The bowel and migraine: update on celiac disease and irritable bowel syndrome. Curr Pain Headache Rep 2012; 16:278-86. [PMID: 22447132 DOI: 10.1007/s11916-012-0258-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article explores possible relationships between migraine, irritable bowel syndrome (IBS), celiac disease (CD), and gluten sensitivity. These seemingly distinct medical entities curiously share many common epidemiological, psychosocial, and pathophysiological similarities. Considerable evidence is emerging to support a concept that experiencing significant threatening adverse events creates a state of hypervigilance in the nervous system, which associates with exaggerated response to future threats and episodic attacks of migraine and IBS. While this sensitizing response is generally considered to reside in the central nervous system, it may be possible that the initiation resides in the enteric nervous system as well. What appears to link migraine, IBS, and CD is a disease model of a genetically sensitive nervous system transformed into one that is hypervigilant, and that over time can often develop disabling and pervasive disease.
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Primary headache syndromes and sinus headache: An approach to diagnosis and management. Auris Nasus Larynx 2012; 39:257-60. [DOI: 10.1016/j.anl.2011.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 04/21/2011] [Accepted: 07/22/2011] [Indexed: 11/23/2022]
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Abstract
In this review we describe the epidemiology, classification, and approach to the diagnosis and treatment of episodic and chronic migraine in children. We review both traditional and alternative medications, and offer a glimpse into the future of pediatric headache.
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Affiliation(s)
- Howard Jacobs
- University of Maryland, Department of Pediatrics, Pediatric Headache Clinic, Baltimore, MD, USA
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Graham SS. Dis-ease or disease?: ontological rarefaction in the medical-industrial complex. THE JOURNAL OF MEDICAL HUMANITIES 2011; 32:167-186. [PMID: 21484314 DOI: 10.1007/s10912-011-9137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Recent scholarship in medical humanities has expressed strong concern over the ability of pharmaceuticals companies to medicalize discomfort and subsequently invent diseases. In this article, I explore the clinical debates over the ontology of the sinus headache as a possible counter-case. Extending Foucault's concept of principles or rarefaction, this paper documents the efforts of clinicians to resist the pharmaceutically-provided understanding of the sinus headache. In so doing, it offers institutions of rarefaction and rarefactive assemblages as useful heuristics for the exploration of disease legitimization discourse.
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Abstract
It is estimated that >24 million cases of acute bacterial sinusitis occur annually in the United States. Recently, a number of medical societies have issued guidelines to aid in the management of upper respiratory tract infections (URIs). Although these guidelines serve to aid practitioners in the proper use of antibiotics, confusion remains regarding the disparity of guideline recommendations as well as some recommendations being outdated. This review presents 3 illustrative case studies designed to provide some clarity with regard to these guidelines. Case 1 is a typical presentation of a patient with worsening sinus conditions over the previous 2 weeks. Case 2 is a more challenging case of a patient with a sinus condition accompanied by a penicillin allergy that ultimately requires referral to an otolaryngologist. Case 3 is an atypical case with symptoms of a sinus infection accompanied by a normal sinus computed tomography scan. It is hoped that the presentation and discussion surrounding these cases will provide some helpful insights into the management of patients with URIs.
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Affiliation(s)
- Jack B Anon
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 16508, USA.
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Sinus headache. Headache 2010. [DOI: 10.1017/cbo9780511750472.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Friedman BW, Grosberg BM. Diagnosis and management of the primary headache disorders in the emergency department setting. Emerg Med Clin North Am 2009; 27:71-87, viii. [PMID: 19218020 PMCID: PMC2676687 DOI: 10.1016/j.emc.2008.09.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Headache continues to be a frequent cause of emergency department (ED) use, accounting for 2% of all visits. Most of these headaches prove to be benign but painful exacerbations of chronic headache disorders, such as migraine, tension-type, and cluster. The goal of ED management is to provide rapid and quick relief of benign headache, without causing undue side effects, and to recognize headaches with malignant course. Although these headaches have distinct epidemiologies and clinical phenotypes, there is overlapping response to therapy; nonsteroidals, triptans, dihydroergotamine, and the antiemetic dopamine antagonists may play a therapeutic role for each of these acute headaches. This article reviews the diagnostic criteria and management strategies for the primary headache disorders.
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Affiliation(s)
- Benjamin Wolkin Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
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Freeman SE, Patil VV, Durham PL. Nitric oxide-proton stimulation of trigeminal ganglion neurons increases mitogen-activated protein kinase and phosphatase expression in neurons and satellite glial cells. Neuroscience 2008; 157:542-55. [PMID: 18938228 PMCID: PMC2642960 DOI: 10.1016/j.neuroscience.2008.09.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 09/16/2008] [Accepted: 09/17/2008] [Indexed: 11/21/2022]
Abstract
Elevated nitric oxide (NO) and proton levels in synovial fluid are implicated in joint pathology. However, signaling pathways stimulated by these molecules that mediate inflammation and pain in the temporomandibular joint (TMJ) have not been investigated. The goal of this study was to determine the effect of NO-proton stimulation of rat trigeminal neurons on the in vivo expression of mitogen-activated protein kinases (MAPKs) and phosphatases (MKPs) in trigeminal ganglion neurons and satellite glial cells. Low levels of the active MAPKs extracellular signal-regulated kinase (ERK), Jun amino-terminal kinase (JNK), and p38 were localized in the cytosol of neurons and satellite glial cells in unstimulated animals. However, increased levels of active ERK and p38, but not JNK, were detected in the cytosol and nucleus of V3 neurons and satellite glial cells 15 min and 2 h following bilateral TMJ injections of an NO donor diluted in pH 5.5 medium. While ERK levels returned to near basal levels 24 h after stimulation, p38 levels remained significantly elevated. In contrast to MKP-2 and MKP-3 levels that were barely detectable in neurons or satellite glial cells, MKP-1 staining was readily observed in satellite glial cells in ganglia from unstimulated animals. However, neuronal and satellite glial cell staining for MKP-1, MKP-2, and MKP-3 was significantly increased in response to NO-protons. Increased active ERK and p38 levels as well as elevated MKP levels were also detected in neurons and satellite glial cells located in V2 and V1 regions of the ganglion. Our data provide evidence that NO-proton stimulation of V3 neurons results in temporal and spatial changes in expression of active ERK and p38 and MKPs in all regions of the ganglion. We propose that in trigeminal ganglia these cellular events, which are involved in peripheral sensitization as well as control of inflammatory and nociceptive responses, may play a role in TMJ pathology.
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Affiliation(s)
- S E Freeman
- Department of Biology, 225 Temple Hall, Missouri State University, Springfield, MO 65897, USA
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Abstract
The understanding of migraine pathophysiology has evolved from the belief that migraine is a vascular disorder, to evidence that better defines migraine as a neurogenic disorder associated with secondary changes in brain perfusion. There is evidence to suggest that the early phase of migraine pain results from neurogenic inflammation affecting cranial blood vessels and dura. Allodynia, hyperalgesia, and expansion of nociceptive fields occur during most well-established migraine attacks. These clinical features of migraine are evocative of those traditionally associated with neuropathic pain. A hypothesis that defines migraine pain as a unique neuropathic pain disorder can imply the potential for neural plasticity and may provide insight into the mechanisms that underlie the transformation of episodic to chronic forms of migraine. The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets. It also lends momentum to an understanding of clinically intriguing topics such as opiate-induced hyperalgesia and medication-overuse headache (rebound headache), opioid resistance in the treatment of chronic headache, and disease modification in defending against the potential for migraine transformation.
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Abstract
Migraine may be responsible for many headaches thought to be caused by the sinuses. Patients complaining of "sinus headache" must have a complete ear, nose, and throat examination. Occasionally, chronic headaches may arise from the sinuses; a thorough history is important to search for symptoms of facial pain and pressure along with other nasal sinus symptoms.
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Nixdorf DR, Velly AM, Alonso AA. Neurovascular pains: implications of migraine for the oral and maxillofacial surgeon. Oral Maxillofac Surg Clin North Am 2008; 20:221-35, vi-vii. [PMID: 18343327 PMCID: PMC2467394 DOI: 10.1016/j.coms.2007.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Epidemiologic studies have shown that migraine headaches are a common finding in the general population, often associated with a high degree of disability. Additionally, migraine has a reported comorbidity with other medical conditions, most notably with chronic pains, such as temporomandibular disorders. The pathophysiologic mechanisms involved with migraine are suggestive of an increased and prolonged hyperexcitability to stimuli, especially within the trigeminal distribution. Because migraine is mediated by branches of the trigeminal nerve it has the potential to mimic other types of pains, such as toothache or sinusitis. It is therefore recommended that oral and maxillofacial surgeons be familiar with the diagnostic criteria for migraine headaches to identify and appropriately treat such individuals who present to their clinics.
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Affiliation(s)
- Donald R Nixdorf
- Division of TMD and Orofacial Pain, University of Minnesota, School of Dentistry, 515 Delaware Street SE, Minneapolis, MN 55455, USA.
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Abstract
Migraine headache occurs frequently in children and adolescents but is often not recognized. This underdiagnosis or misdiagnosis results in inappropriate and potentially ineffective treatments. A variety of factors may contribute to this deficiency, including limitations in the current standardized criteria, as well as patient, parent, and care providers' misassumption as to the etiology. The standardized criteria that have been developed to assist with the recognition and accurate diagnoses have recently been revised (the International Classification of Headache Disorders II). These criteria provide the scientific basis for the study of headache, including the determination of the incidence and prevalence of pediatric migraine.
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Affiliation(s)
- Paul Winner
- Palm Beach Headache Center, 4631 North Congress Avenue, West Palm Beach, FL 33407, USA.
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Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC, Hudgins PA, Jones S, Krouse HJ, Lee LH, Mahoney MC, Marple BF, Mitchell CJP, Nathan R, Shiffman RN, Smith TL, Witsell DL. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007; 137:S1-31. [PMID: 17761281 DOI: 10.1016/j.otohns.2007.06.726] [Citation(s) in RCA: 626] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Revised: 06/20/2007] [Accepted: 06/20/2007] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This guideline provides evidence-based recommendations on managing sinusitis, defined as symptomatic inflammation of the paranasal sinuses. Sinusitis affects 1 in 7 adults in the United States, resulting in about 31 million individuals diagnosed each year. Since sinusitis almost always involves the nasal cavity, the term rhinosinusitis is preferred. The guideline target patient is aged 18 years or older with uncomplicated rhinosinusitis, evaluated in any setting in which an adult with rhinosinusitis would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with sinusitis. PURPOSE The primary purpose of this guideline is to improve diagnostic accuracy for adult rhinosinusitis, reduce inappropriate antibiotic use, reduce inappropriate use of radiographic imaging, and promote appropriate use of ancillary tests that include nasal endoscopy, computed tomography, and testing for allergy and immune function. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of allergy, emergency medicine, family medicine, health insurance, immunology, infectious disease, internal medicine, medical informatics, nursing, otolaryngology-head and neck surgery, pulmonology, and radiology. RESULTS The panel made strong recommendations that 1) clinicians should distinguish presumed acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions, and a clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening), and 2) the management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain. The panel made a recommendation against radiographic imaging for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected. The panel made recommendations that 1) if a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin as first-line therapy for most adults, 2) if the patient worsens or fails to improve with the initial management option by 7 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications, 3) clinicians should distinguish chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms, 4) clinicians should assess the patient with CRS or recurrent acute rhinosinusitis for factors that modify management, such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, and anatomic variation, 5) the clinician should corroborate a diagnosis and/or investigate for underlying causes of CRS and recurrent acute rhinosinusitis, 6) the clinician should obtain computed tomography of the paranasal sinuses in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 7) clinicians should educate/counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures. The panel offered as options that 1) clinicians may prescribe symptomatic relief in managing viral rhinosinusitis, 2) clinicians may prescribe symptomatic relief in managing ABRS, 3) observation without use of antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness (mild pain and temperature <38.3 degrees C or 101 degrees F) and assurance of follow-up, 4) the clinician may obtain nasal endoscopy in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 5) the clinician may obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent acute rhinosinusitis. DISCLAIMER This clinical practice guideline is not intended as a sole source of guidance for managing adults with rhinosinusitis. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, NY 11201-5514, USA.
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Moloney MF, Strickland OL, DeRossett SE, Melby MK, Dietrich AS. The experiences of midlife women with migraines. J Nurs Scholarsh 2006; 38:278-85. [PMID: 17044346 DOI: 10.1111/j.1547-5069.2006.00114.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the experiences of midlife women with migraines. DESIGN AND METHODS Qualitative data were collected in two consecutive studies, using open-ended interviews, focus groups, and online discussion boards. Interpretive methods were used for analysis. FINDINGS Three patterns were identified: Changing Headache Patterns; Predicting, Preventing, and Controlling Headaches; and Keeping on the Move. These patterns indicated how women's headaches changed over time, how headaches were envisioned within the context of their lives, what strategies were used to meet work and home responsibilities, and how women controlled their headaches while maintaining a sense of perspective. CONCLUSIONS Many midlife women with migraines receive inadequate or inappropriate treatment, and better dissemination of current diagnostic and treatment guidelines is necessary. Ongoing research is needed to increase understanding of how this problem affects midlife women's lives and of what interventions might prevent or alleviate migraine discomfort.
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Affiliation(s)
- Margaret F Moloney
- Byrdine F Lewis School of Nursing, Georgia State University, Atlanta 30302-4019, USA.
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