Etiology of ‘Sinus Headache’—Moving the Focus from Rhinology to Neurology. A Systematic Review

‘Sinus headache and/or facial pain’ (SH) is a common complaint encountered by otorhinolaryngologists, neurologists and general practitioners. However, several studies suggested that the majority of those cases may be attributed to primary headaches (i.e., migraine and tension-type headache (TTH). The purpose of this review is to evaluate the etiology of SH. The first part includes cross-sectional studies analyzing the prevalence of respective diagnoses in subjects with SH. The majority of these publications indicate that migraine and TTH are the most prevalent causes of SH, although most of these studies were conducted in a clinical setting. The second part of this review included treatment trials in subjects with SH. The findings from this part of the review show that SH without rhinosinusitis responds well to pharmacotherapy targeted at primary headaches. This observation further supports a neurologic etiology of the majority of SH cases.

Nasal and sinus headaches

Very few topics in the headache field engender more controversy than sinus headache. Patients often believe that their headaches are attributed to sinus disorders because they experience rhinitis symptoms (e.g. rhinorrhoea, nasal congestion, and postnasal drip) during their attacks. Primary care physicians, otolaryngologists, and allergists often diagnose sinus headaches and treat them with rhinitis medications, antibiotics, allergy shots, and surgical interventions, with varying levels of success. In contrast, most neurologists and headache specialists believe that many patients with a diagnosis of sinus headache are suffering from migraine, or another primary headache disorder.

Do you really have sinus headache?

<p class="abstract"><strong>Background:</strong> Headache is a common symptom. Correct diagnosis of the etiology is the key to successful treatment. Chronic headache are misdiagnosed as sinus headache because of presence of overlapping symptoms leading to unnecessary treatment with no relief to the patient. We decided to undertake this study with the objective of evaluating patients with chronic headache for presence of chronic rhinosinusitis and hence assess the contribution of sinus headache to chronic headache.</p><p class="abstract"><strong>Methods:</strong> The present study was conducted at Adichunchanagiri Institute of Medical Sciences, BG Nagara during the period January 2018 to December 2018. Patients presenting to OPD with chronic headache previously diagnosed as sinus headache were included in the study. A total of 174 patients were studied. All patients underwent detailed history taking, detailed ENT examination, and diagnostic nasal endoscopy. AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headache were used for diagnosis. </p><p class="abstract"><strong>Results:</strong> We found that only 13% (n=23) cases had chronic rhinosinusitis and hence diagnosed as sinus headache. 53% (n=92) had migraine, 31% (n=54) had tension type headache and 3% (n=5) could not be categorized.</p><p class="abstract"><strong>Conclusions:</strong> Prevalence of sinus headache in our study was found to be 13%. There are high chances of misdiagnosing chronic headache as sinus headache because primary forms of headache can present with nasal symptoms. The AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headaches are very useful and effective in making an accurate diagnosis.</p>