Case report: Endoscopic frontal sinus opening surgery for noninflammatory frontal sinus headache: A short case series.

Objective: The objectives of this study were to analyze rhinogenic headache, i.e., noninflammatory frontal sinus headache, a headache caused by bony obstruction of the frontal sinus drainage channels that receives relatively insufficient attention clinically, and to propose endoscopic frontal sinus opening surgery as a treatment based on the etiology. Study Design: Case series. Setting: From the data of patients with noninflammatory frontal sinus headache who underwent endoscopic frontal sinus surgery in Hospital of Chengdu University of Traditional Chinese Medicine during 2016-2021, data for three cases with detailed postoperative follow-up data were extracted for case series reports. Methods: This report provides detailed information on three patients with noninflammatory frontal sinusitis headache. Treatment options include surgery and rechecking, with the visual analogue scale (VAS) scores of preoperative and postoperative symptoms, CT, and endoscopic images. Three patients had common characteristics: the clinical manifestations were recurrent or persistent with pain and discomfort in the forehead area, but there was no nasal obstruction or runny nose; the paranasal sinus CT revealed no signs of inflammation in the sinuses but suggested bony obstruction of the drainage channel of the frontal sinus. Results: All three patients had recovery from headache, nasal mucosal recovery, and patent frontal sinus drainage. The recurrence rate of forehead tightness and discomfort or pain was 0. Conclusion: Noninflammatory frontal sinus headache does exist. Endoscopic frontal sinus opening surgery is a feasible treatment modality that can largely or even completely eliminate the stuffy swelling and pain in the forehead. The diagnosis and surgical indications for this disease are based on a combination of anatomical abnormalities and clinical symptoms.

Clinical Outcome Following Endoscopic Septoturbinal Surgeries for Rhinogenic Contact Point Headache: A Retrospective Analysis.

To assess the clinical outcome of endoscopic septoturbinal surgeries in patients with rhinogenic contact point headache. Retrospective audit of medical records. Retrospective audit of medical records of patients having undergone endoscopic surgical management for contact point headache between a period of May 2017 to May 2018 were included in the study. Patients who underwent functional endoscopic sinus surgery were excluded from the study. Pre operative pain score were compared with post operative pain score at interval of 1 month for 3 months consequently and at 1 year interval using Visual Analog scale (VAS). The difference between preoperative (mean 6.82) and post operative VAS pain scores after 1 month (mean 3.36), 2 months (mean 4.50), 3 months (mean 5.48), 1 year (mean 5.01) was statistically significant (p < 0.001). Contact point headache is an important clinical entity that might be missed during evaluation and management of refractory headache. Surgical management under endoscopic guidance can help to ensure removal of mucosal contact point and aid in the treatment of refractory headache as noted in our study.

Headache Diagnosis in Children and Adolescents.

Pediatric headache is a common medical complaint managed across multiple subspecialties with a myriad of unique factors (clinical presentation and disease phenotype) that make accurate diagnosis particularly elusive. A thorough understanding of the stepwise approach to headache disorders in children is essential to ensure appropriate evaluation, timely diagnosis, and efficacious treatment. This work aims to review key components of a comprehensive headache assessment as well as discuss primary and secondary headache disorders observed in children, with a particular focus on clinical pearls and "red flag" symptoms necessitating ancillary diagnostic testing.

A Comparative Study of CT Scan and Nasal Endoscopic Findings of Lateral Wall of Nose, in Headache of Rhinogenic Origin.

Headache disorders are rated among the ten most disabling conditions worldwide. Contact points like septal spur, septal deviation, concha bullosa and bulla ethmoidalis can cause rhinogenic headache (RH). Diagnostic nasal endoscopy (DNE) is an essential part of evaluation of sinonasal disease and is the key to understanding anatomical variations. As compared to CT paranasal sinus (CT PNS), DNE is cheaper and has wider availability, being part of the basic training of present ENT curriculum. We conducted a prospective observational study from September 2018 to June 2020 on 202 patients who were diagnosed to have RH. The aim of this study was to the define the role of DNE as the primary examination for early and accurate diagnosis of rhinogenic headache as compared to CT PNS. RH patients were evaluated with DNE followed by CT PNS. Evaluation of the findings of anatomical variations of lateral wall of nose on DNE and CT PNS was done. In our study the most common anatomic variations in order of frequency in both DNE and CT PNS was deviated nasal septum, impacting spur and unilateral concha bullosa. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DNE for the various anatomical variations was statistically better than CT PNS findings. We conclude that DNE is a better than CT PNS as a diagnostic technique to detect various anatomical variations, thus initiating early management of RH.

Rhinogenic contact point headache mimicking odontogenic pain: A case report and review of literature.

Headache is a common clinical problem, and appropriate diagnosis and management are a challenge for oral physician. Any minor anatomical variation within the nasal cavity may lead to mucosal contact point, which may be an etiological factor for causing headache and often left behind by clinician during preliminary evaluation of patients with headache or facial pain, resulting in misdiagnosis and inappropriate treatment. This article is an attempt to present a case of rhinogenic contact point headache which may be mistaken for a toothache initially leading to incorrect diagnosis and irrelevant treatment. A thorough, accurate and comprehensive history taking and a complete clinical and general physical examination result in appropriate diagnosis of the clinical situation.

Rhinogenic Headache in Children and Adolescents.

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.

Is septoplasty effective rhinogenic headache in patients with isolated contact point between inferior turbinate and septal spur?

BACKGROUND: Rhinogenic headache is a painful sensation in the head and face due to intranasal contact point without any mass or inflammatory findings. Surgery is recommended in patients with nasal obstruction; however the approach in case of isolated mucosal contact point that does not cause obstruction is controversial. Our aim is to observe changes in the severity of headache in patients with isolated mucosal contact point and headache who do not complain of nasal obstruction. METHODS: Our study included patients with unilateral headache without any nasal and/or paranasal sinus pathology. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography (CT). One hundred patients with isolated mucosal contact point without any problem in breathing were included in this study. All participants were treated by topical nasal corticosteroid for a month. Surgery was recommended to the patients with no satisfactory relieve of headache. Visual Analog Scales (VAS) were used to evaluate the severity of headache in patients at time of diagnosis (0 month), after a medical treatment (1st month) and after a surgical or medical treatment (6th month). The results were compared with each other statistically. RESULTS: There was a decrease in VAS values after a month of medical treatment in all patients with isolated contact point (Z = -8.352; p = 0.0). VAS values significantly improved after surgical treatment group (Z = -4.97; p = 0.0). However, VAS values of patients increased at 6th month in medical treatment group (Z = -5341 p = 0.0). After a successful surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with surgical treatment group than in the patients with medical treatment group (Z = -8.441; p = 0.0). CONCLUSION: Surgical correction provides a more effective outcome in patients with rhinogenic headache. However, it is difficult to convince that headache may improve with surgery in these patients especially with isolated mucosal contact point and without nasal obstruction. In order to prove the benefit of surgery, we believe that medical treatment can be used as a guide.

Rhinogenic headache in pediatric and adolescent patients: an evidence-based review.

BACKGROUND: Although some causes of rhinogenic headache, such as acute sinusitis, have clear diagnostic criteria, others, such as "sinus headache" and mucosal contact points, are more nebulous. Misdiagnosis of these entities and primary headaches may result in unnecessary medical or surgical treatment. The purpose of this systematic review is to delineate current understanding of diagnosis and treatment of rhinogenic headaches, including sinus and mucosal contact point headaches, in children. METHODS: PubMed, SCOPUS, and the Cochrane databases were searched for studies on sinus headache and mucosal contact point headaches in children. Studies were assessed for level of evidence, and risk of bias was assessed by Methodological Index for Non-Randomized Studies (MINORS) scoring. Diagnostic criteria, management strategies, and other clinical data were analyzed. RESULTS: Eight studies met the inclusion criteria. Level of evidence was predominantly 4. Forty percent of pediatric patients with migraine had been previously misdiagnosed with sinus headache. Of 327 pediatric patients in two studies, between 55% and 73% had at least 1 cranial autonomic symptom associated with their migraine. For children with mucosal contact point headaches, surgical management in select patients improved headache intensity or severity in 17 (89%) cases. CONCLUSION: The majority of pediatric patients with sinus headache harbor a primary headache disorder, with migraine being most common. Physicians should suspect primary headache disorders in pediatric patients with chronic headaches and a normal exam. Although some case series are supportive of surgical management for mucosal contact point headaches in children, the level of evidence supporting these recommendations is insufficient. High-quality clinical trials are necessary for continuing to improve outcomes in patients with these clinical entities.

[Differential diagnostics of headache associated with pathological changes in the nasal cavity and paranasal sinuses]. / Differentsial'naia diagnostika golovnoi boli pri patologii polosti nosa i okolonosovykh pazukh.

Headache is not infrequently one of the major complaints in the patients visiting the otorhinolaryngologist's office. It was estimated to occur in 24% of the patients presenting with chronic sinusitis. The cause of headache may be pathological processes either in the nasal cavity or in the paranasal sinuses as well as a primary disorder in the nervous system. The present article is concerned with the peculiar features of rhinogenic headache and that of a different etiology. It was shown that the patients suffering from headache are in need not only of the obligatory otorhinolaryngological examination including endoscopy of the nasal cavity, X-ray study and, sometimes, specialized tests but also of neurological counseling. However, the surgical treatment does not always results in the elimination or relief of the rhinogenic headache. Hence, the importance of the evaluation of the risks and benefits of such treatment for an individual patient. The formation of the contact points in the nasal mucosa is considered to be one of the possible causes of rhinogenic headache. However, this opinion needs to be confirmed by the results of large-scale comparative clinical studies.

The Role of Balloon Sinuplasty in the Treatment of Vacuum Rhinogenic Headache.

In this study we tried to demonstrate how balloon sinuplasty could be an option in the treatment of the Rhinogenic Headache due to a probably disventilation of frontal sinus recess. 107 patients were included in the study with diagnosis of Rhinogenic Headache. The surgical group underwent bilateral balloon sinuplasty of the frontal sinus. The medical group underwent pharmacological treatment. Headaches characteristics were evaluated by a clinical personal diary. The severity was recorded by Visual Analog Scale 4 and 8 months after treatment. 98 out of 107 patients completed the protocol. In surgical group and in medical one the mean headache score improved at four and eight months follow up. The headache frequency attacks per month decrease from a preoperative frequency of 18 (±4 SD) in surgical group and 17 (±3 SD) in medical group to 3 (±1 SD) and 6 (±3 SD) respectively at 4 months control but increased slightly to 5 (±2 SD) and 12 (±4 SD) after 8 months. We concluded that the balloon sinuplasty should be considered as an effective alternative option after an accurate selection of surgical candidates. However, it is important a 6-8 month follow-up to evaluate the efficacy and stability of the treatment used.

[Headache: Otorhinolaryngological aspects]. / Kopfschmerzen: Hals-Nasen-Ohren-ärztliche Aspekte.

Headache is the main symptom in a wide variety of diseases of which ear, nose and throat (ENT) entities are only a small fraction but are not reflected in the number of patients. Comprehensive knowledge of the clinical signs of the most common primary headaches, e. g. migraine, is therefore essential for the ENT specialist because the few patients with secondary headache from ENT-related causes must be identified. Reasons for confusing primary headache with e. g. sinusitis are mostly symptoms mediated by the trigeminal nerve, such as nasal obstruction and rhinorrhea because branches of the trigeminal nerve also innervate the meninges. The ENT-specific origin of headaches is characterized by clinical findings of physical organ disease; therefore, from an ENT perspective imaging should be part of the diagnostic procedure as normal imaging findings are indicative of primary headache, which would not normally be treated by an ENT specialist.

Rhinogenic Headache: The International Classification of Headache Disorders, 3rd Edition / 대한이비인후과학회지

Rhinogenic headache may be defined as a headache directly caused by pathology within the nose or paranasal sinuses. Rhinogenic headache is a controversial, but distinct type of headache that has received an increased amount of attention in the literature over the past twenty years. The International Classification of Headache Disorders, 3rd edition has been released by the 'International Headache Society' in May 2013. As this version is based on a large body of research on headache, in contrast to previous editions that were mostly based on opinion of experts, it is being considered as a major step forward in the diagnosis and management of headache. The International Headache Society presented the diagnostic criteria of rhinogenic headache divided into three types: Headache Attributed to Acute Rhinosinusitis, Headache Attributed to Chronic or Recurring Rhinosinusitis, Headache Attributed to Disorder of the Nasal Mucosa, Turbinates or Septum. We herein present the salient features of the new classification, which are likely to be of interest to the rhinologist. In addition, I review the evidence that intranasal mucosal contact points cause facial pain or headache and present the important points to consider in diagnosis and treatment of mucosal contact point headache.

Radiofrequency Diathermy for Rhinogenic Headache / 대한이비인후과학회지

Rhinogenic headache is a headache or facial pain syndrome secondary to mucosal contact points or rhinogenic causes in the absence of rhinitis/sinusitis. The authors report a case of atypical rhinogenic headache in a 72-year-old woman who presented with recurrent right side headache, which was aggravated by nasal breathing. A computed tomographic scan showed no evidence of rhinosinusitis and mucosal contact points. However, during nasal endoscopy, she had multiple pain-trigger points on the septum and lateral nasal wall. Treatment involved endoscopic reduction and radiofrequency diathermy of the pain-trigger point. Postoperatively, the headache was successfully relieved, and there was no evidence of recurrence. In this article, the authors present surgical option for the treatment of atypical rhinogenic headache.

Imaging for headache: what the otolaryngologist looks for.

Diagnosing a rhinogenic cause of headache or facial pain outside of the classic definitions of chronic, acute, and subacute sinusitis can be challenging for the practicing otolaryngologist. Contact-point headaches have been clinically characterized as causing facial pain secondary to abutting mucosal contact from the lateral nasal wall to the septum. Imaging landmarks may help identify these potential contact points radiographically through revealing anatomic variants such as septal spurs and abnormally large lateral nasal structures. However, other potential rhinologic sources, such as barosinusitis, recurrent barotrauma, or recurrent acute sinusitis occurring between active episodes, are challenging to identify through hallmark imaging findings.

What do we know about rhinogenic headache? The otolaryngologist's challenge.

Sinus headache is a common presenting complaint in the otolaryngology office. Although most patients with this presentation are found to have migraine headache, many do not, and others fail therapy. This review focuses on the current understanding of nonneoplastic rhinogenic headache: headaches that are caused or exacerbated by nasal or paranasal sinus disease or anatomy. The literature regarding this topic is reviewed, along with a review of surgical series seeking to correct these abnormalities and the outcomes obtained with intervention. Suggestions are provided regarding patient diagnosis and management, and options for intervention are reviewed.

Evaluation and management of "sinus headache" in the otolaryngology practice.

Patients, primary care doctors, neurologists and otolaryngologists often have differing views on what is truly causing headache in the sinonasal region. This review discusses common primary headache diagnoses that can masquerade as "sinus headache" or "rhinogenic headache," such as migraine, trigeminal neuralgia, tension-type headache, temporomandibular joint dysfunction, giant cell arteritis (also known as temporal arteritis) and medication overuse headache, as well as the trigeminal autonomic cephalalgias, including cluster headache, paroxysmal hemicrania, and hemicrania continua. Diagnostic criteria are discussed and evidence outlined that allows physicians to make better clinical diagnoses and point patients toward better treatment options.

Endoscopic intranasal structure reconstruction surgery in treating rhinogenic headache / 局解手术学杂志

Objective To investigate the efficacy of endoscopic intranasal structure reconstruction surgery for rhinogenous headache. Methods 82 cases of rhinogenous headache were given endoscopic intranasal structure reconstruction. Compared VAS scores before and 6 months after treatment, counted the effective rate. Results Among the 82 patients, 69 patients(84. 1%) were cured, 8 cases (9. 8%) were of obvious effect, 5 cases (6. 1%) were invalid, and the total efficiency was 93. 9%. VAS scores of the mucosal contact headache group before treatment were greater than that of the sinus headache group (P0. 05). Conclusion Endoscopic surgical operation can remove the extrusion of the nasal cavity and paranasal sinuses and factors of nasal congestion, and then reconstruct normal anatomical structure of nasal cavity, thus restoring normal function of paranasal sinuses. It has good therapeutic effect on rhinogenic headache.

Endoscopic management of contact point headache in patients resistant to medical treatment.

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.