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Rhinopathic Headaches

Referred Pain of Nasal and Sinus Origin

  • Chapter
Diseases of the Sinuses

Abstract

Headache is universal in the human experience. Despite the familiarity most of us have with the symptom, the cause of most headaches remains a mystery. Much of modern research has focused on headache mechanisms (such as spreading cerebral electrical depression, serotonin receptor properties, and vasodilatory mechanisms) rather than headache causation. Pain referred from the sinonasal tract is one preventable cause of headache. The anatomical basis for the relationship between headache and the sinonasal tract is the trigeminal nerve (CN V). The fifth cranial nerve not only provides sensory fibers to the nasal cavity and paranasal sinuses, but innervates pain-sensitive structures in the cranial cavity, such as dura and intracranial blood vessels, thus providing the basis for referred headache. The headache and facial pain that accompany acute sinusitis are fairly well recognized, chiefly owing to the obvious nasal symptoms, such as purulent rhinorrhea, nasal congestion and obstruction, post-nasal drip, and cough. The concept of headache referred from the sinonasal cavity without overt nasal symptoms or gross mucosal disease is rapidly gaining acceptance, largely owing to the enhanced diagnostic capabilities afforded by rigid nasal endoscopy and coronal computed tomography (CT). This chapter will focus on headache as a symptom of various sinonasal pathophysiologic processes, which may or may not be accompanied by nasal symptoms or inflammatory sinus disease. The term “primary headache” will be used in this chapter to denote the vascular- or tension-type headaches (migraine, cluster, chronic daily headache, tension headache, and so on) traditionally thought to be unrelated to any underlying organic pathology.

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References

  1. Mayer DJ, Frenk H. The role of neuropeptides in pain. In: Nemeroff CB, ed., Neuropeptides in Psychiatric and Neurological Disorders. Baltimore: Johns Hopkins University Press. 1988; p. 201.

    Google Scholar 

  2. Sessle BJ. Neural mechanisms of oral and facial pain. Otolaryngol Clin North Amer 1989;21:1059–1072.

    Google Scholar 

  3. Finger TE, et al. Affector and effector functions of peptidergic innervation of the nasal cavity. In: Green BG, Mason JR, Kare MR, eds., Chemical Senses, Vol. 2: Irritation. New York: Marcel Dekker, 1990; pp. 1–17.

    Google Scholar 

  4. Lucier GE, Egizii R. Characterization of cat nasal afferents and brain stem neurones receiving ethmoidal input. Exp Neurol 1989; 103:83–89.

    Article  PubMed  CAS  Google Scholar 

  5. Lucier GE, Egizii R. Central projections of the ethmoidal nerve of the cat as determined by the horseradish peroxidase tracer technique. J Comp Neurol 1986; 247:123–132.

    Article  PubMed  CAS  Google Scholar 

  6. Sicuteri F, Fanciullacci M, Nicolodi M, Geppetti P, Fusco BM, Marabini S, Alessandri M, Campagnolo V. Substance P theory: a unique focus on the painful and painless phenomena of cluster headache. Headache 1990;30:69–79.

    Article  PubMed  CAS  Google Scholar 

  7. Lundblad L, Lundberg JM, Brodin E, Änggård A. Origin and distribution of capsaicin-sensitive substance P-immunoreactive nerves in the nasal mucosa. Acta Otolaryngol 1983;96:485–493.

    Article  PubMed  CAS  Google Scholar 

  8. Silver WL, Farley LG, Finger TE. The effects of neonatal capsaicin administration on trigeminal nerve chemoreceptors in the rat nasal cavity. Brain Res 1991;561: 212–216.

    Article  PubMed  CAS  Google Scholar 

  9. Melzack R, Wall PD. Pain and mechanisms: a new theory. Science 1965; 150:971–979.

    Article  PubMed  CAS  Google Scholar 

  10. Clerico DM. Sinus headaches reconsidered: referred cephalgia of rhinologic origin masquerading as refractory primary headaches. Headache 1995;35:185–192.

    Article  PubMed  CAS  Google Scholar 

  11. Maggi CA, Meli A. The sensory-efferent function of capsaicin-sensitive neurons. Gen Pharmacol 1988; 19: 1–43.

    Article  PubMed  CAS  Google Scholar 

  12. Silver WL, Finger TE. The trigeminal system. In: Getchell TV, Doty RL, Bartoshuk LM, Snow JB Jr, eds., Smell and Taste in Health and Disease. New York: Raven, 1991; p.

    Google Scholar 

  13. Eccles R. Neurological and pharmacological considerations. In: Proctor DF, Andersen I, eds., The Nose: Upper Airway Physiology and the Atmospheric Environment. Amsterdam: Elsevier, 1982; pp. 191–214 (198-202).

    Google Scholar 

  14. Raphael GD, Meredith SD, Baraniuk JN, Kaliner MA. Nasal reflexes. In: Settipane GA, ed., Rhinitis, 2nd ed. Providence, RI: OceanSide, 1991; pp. 135–14

    Google Scholar 

  15. In: Dalessio DJ, Silberstein SD, eds., Wolffs Headache and Other Head Pain, 6th ed. New York: Oxford University Press, 1993; pp. 297–305.

    Google Scholar 

  16. Wolff HG. Headache and Other Head Pain. Oxford University Press, New York, 1948; p. 548.

    Google Scholar 

  17. Fairley JW, Yardley MPJ, Durham LH. Pressure applied to middle turbinate causes pain at lower threshold than inferior turbinate or nasal septum (Abstract). Abstract book—14th Congress European Rhinologic Society, Rome, Oct. 6–10, 1992;96.

    Google Scholar 

  18. Pearce JMS. Chronic headache: the role of deformity of the nasal septum (letter to the editor). Br Med J 1984; 288:1005.

    Article  Google Scholar 

  19. Takeshima T, Nishikawa S, Takahashi K. Cluster headache like symptoms due to sinusitis: evidence for neuronal pathogenesis of cluster headache syndrome. Headache 1988;28:207,208.

    Article  PubMed  CAS  Google Scholar 

  20. Faleck H, Rothner AD, Erenberg G, Cruse RP. Headache and subacute sinusitis in children and adolescents. Headache 1988;28:96–98.

    Article  PubMed  CAS  Google Scholar 

  21. Levine HL. Headache associated with sinus disease. In: Tollison CD, Kunkel RS, eds., Headache: Diagnosis and Treatment. Baltimore: Williams & Wilkins, 1993; pp. 247–256.

    Google Scholar 

  22. Rosenblum BN, Friedman WH. Paranasal sinus etiologies of headache and facial pain. In: Jacobson AL, Donlon WC, eds., Headache and Facial Pain. New York: Raven, 1990; pp. 233–244.

    Google Scholar 

  23. Friedman WH, Rosenblum BN. Paranasal sinus etiology of headaches and facial pain. Otolaryngol Clin North Amer 1989;22:1217–1228.

    CAS  Google Scholar 

  24. Kennedy DW, ed., Sinus Disease: Guide to First-Line Management. Darien, CT: Health Communications, 1994; pp. 22–26.

    Google Scholar 

  25. Kennedy DW, Loury MC. Nasal and sinus pain: current diagnosis and treatment. Sem Neurol 1988;8:303–314.

    Article  CAS  Google Scholar 

  26. Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg 1991; 104: 480–483.

    PubMed  CAS  Google Scholar 

  27. Havas TE, Motbey JA, Gullane PJ. Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 1988;114:856–859.

    Article  PubMed  CAS  Google Scholar 

  28. Wells WA. Some nervous and mental manifestations occurring in connection with nasal disease. Am J Med Sci 1898;116:677–692.

    Article  Google Scholar 

  29. Roe JO. The frequent dependence of persistent and so-called congestive headaches upon abnormal conditions of the nasal passages. Med Record 1888;34:200–204.

    Google Scholar 

  30. Wolff HG. Headache and other head pain. Oxford University Press, New York, 1948; p. 499.

    Google Scholar 

  31. Eagle WW. Sphenopalatine ganglion neuralgia. Arch Otolaryngol 1942;35:66.

    Article  Google Scholar 

  32. Vail HH. Vidian neuralgia. Ann Otol 1932;41:837–846.

    Google Scholar 

  33. Stewart D, Lambert V. The sphenopalatine ganglion. J Laryngol 1930;45:753–758.

    Article  Google Scholar 

  34. Cushing H. The major trigeminal neuralgias and their surgical treatment, based on experiences with 332 Gasserian operations. The varieties of facial neuralgia. Am J Med Sci 1920;160:157–163.

    Article  Google Scholar 

  35. Wolff HG. Headache and other head pains. Oxford University Press, New York, 1948; p. 502.

    Google Scholar 

  36. Manzoni GC, Prusinski A. Cluster headache. In: Olesen J, Tfelt-Hansen P, Welch KMA, eds., The Headaches. New York: Raven, 1993; p. 544.

    Google Scholar 

  37. Pratt FJ, Pratt JA. Intranasal Surgery. FA Davis, Philadelphia, 1924.

    Google Scholar 

  38. Bolger WE, Parsons DS, Matson RE. Functional endoscopic sinus surgery in aviators with recurrent sinus barotrauma. Aviat Space Environ Med 1990;61:148–156.

    PubMed  CAS  Google Scholar 

  39. Bolger WE, Parsons DS. Treatment of recurrent sinus barotrauma in aviators: comparison of functional endoscopic and “classic” sinus surgery techniques. Am J Rhinol 1990;4:75–81.

    Article  Google Scholar 

  40. Robbins L. Precipitating factors in migraine: a retrospective review of 494 patients. Headache 1994;34: 214–216.

    Article  PubMed  CAS  Google Scholar 

  41. Fairley JW. Personal communication.

    Google Scholar 

  42. Goldsmith AJ, Zahtz GD, Stegnjajic A, Shikowitz M. Middle turbinate headache syndrome. Am J Rhinol 1993;7:17–23.

    Article  Google Scholar 

  43. Saunte C, Soyka D. Headache related to ear, nose, and sinus disorders. In: Olesen J, Tfelt-Hansen P, Welch KMA, eds., The Headaches. New York: Raven, 1993; pp. 753–757.

    Google Scholar 

  44. Ryan RE Sr, Ryan RE Jr. Headache of nasal origin. Headache 1979;19:170–173.

    Article  Google Scholar 

  45. Koch-Henriksen N, Gammelgaard N, Hvidegaard T, Stoksted P. Chronic headache: the role of deformity of the nasal septum. Br Med J 1984;288:434,435.

    Article  CAS  Google Scholar 

  46. Clerico DM, Fieldman RF. Referred headache of rhinogenic origin in the absence of sinusitis. Headache 1994;34:226–229.

    Article  PubMed  CAS  Google Scholar 

  47. Greenfield HJ. Headache and facial pain associated with nasal and sinus disorders: a diagnostic and therapeutic challenge. Part I. Insights in Otolaryngol 1990;5:2–8.

    Google Scholar 

  48. Greenfield HJ. Headache and facial pain associated with nasal and sinus disorders: a diagnostic and therapeutic challenge. Part II: Clinical application. Insights in Otolaryngol 1991;6:2–8.

    Google Scholar 

  49. Schonsted-Madsen U, Stoksted P, Christensen PH, Koch-Henriksen N. Chronic headache related to nasal obstruction. J Laryngol Otol 1986; 100:165–170.

    Article  PubMed  CAS  Google Scholar 

  50. Chow JM. Rhinologic headaches. Otolaryngol Head Neck Surg 1994; 111:211–218.

    Article  PubMed  CAS  Google Scholar 

  51. Castellanos J, Axelrod D. Flexible fiberoptic rhinoscopy in the diagnosis of sinusitis. J Allergy Clin Immunol 1989;83:91–94.

    Article  PubMed  CAS  Google Scholar 

  52. Cook PR, Nishioka GJ, Davis WE, McKinsey JP. Functional endoscopic sinus surgery in patients with normal computed tomography scans. Otolaryngol Head Neck Surg 1994; 110:505–509.

    PubMed  CAS  Google Scholar 

  53. Stammberger H, Wolf G. Headaches and sinus disease: the endoscopic approach. Ann Otol Rhinol Laryngol 1988;97(suppl. 134):3–23.

    Google Scholar 

  54. Stammberger H. Functional endoscopic sinus surgery. Philadelphia: BC Decker, 1991; p. 444.

    Google Scholar 

  55. Bonaccorsi P. Primary headaches compared with idiopathic rhinogenic headaches: the actual diagnostic misunderstandings. European Rhinologic Society Annual Meeting, 1988.

    Google Scholar 

  56. Bonaccorsi P. Surgical therapy (neurovascular decompressive ethmoido-sphenoidectomy) and prophylaxis during developmental age of common, classic, complicated migraine and of cluster headache with rhinogenic pathogenesis. In: The Anatomo-Surgical approach to Treatment of Migraine. Up-to-Date Meeting on Headache, Florence, Italy. Nov. 23, 1985: pp. 22–44.

    Google Scholar 

  57. Hoover S. Nasal pathophysiology of headaches and migraines. Rhinol 1988;26(suppl. 2):111–115.

    Google Scholar 

  58. Thomas WC. Obscure sinus infections. Med Times 1960;88:199–206.

    PubMed  CAS  Google Scholar 

  59. Sicuteri F, Fusco BM, Marabini S, Campagnolo V, Maggi CA, Geppetti P, Fanciullacci M. Beneficial effect of capsicin application to the nasal mucosa in cluster headache. Clin J Pain 1989;5:49–53.

    Article  PubMed  CAS  Google Scholar 

  60. Fusco BM, Geppetti P, Fanciullacci M, Sicuteri F. Local application of capsicin for the treatment of cluster headache and trigeminal neuralgia. Cephalalgia 1991; 11 (suppl. 11):234,235.

    Google Scholar 

  61. Stone H, Williams B, Carregal EJA. The role of the trigeminal nerve in olfaction. ExpNeurol 1968;21:11–19.

    CAS  Google Scholar 

  62. Ulrich CE, Haddock MP, Alarie Y. Airborne chemical irritants, role of the trigeminal nerve. Arch Environ Health 1972;24:37–42.

    PubMed  CAS  Google Scholar 

  63. Fusco BM, Fiore G, Gallo F, Martelletti P, Giacovazzo M. “Capsaicin-sensitive” sensory neurons in cluster headache: pathophysiological aspects and therapeutic indication. Headache 1994;34:132–137.

    Article  PubMed  CAS  Google Scholar 

  64. Lewis JL, Hahn FF, Dahl AR. Transport of inhaled toxicants to the central nervous system: characteristics of a nose-brain barrier. In: Isaacson RL, Jensen KF, eds., The vulnerable brain and environmental risks, Vol 3: Toxins in Air and Water. New York: Plenum, 1994; pp. 77–103.

    Google Scholar 

  65. Calderon-Garciduenas L, Osorno-Velazquez A, Bravo-Alvarez H, Delgado-Chavez R, Barrios-Marquez R. Histopathologic changes of the nasal mucosa in southwest metropolitan Mexico City inhabitants. Am J Pathol 1992; 140:225–231.

    PubMed  CAS  Google Scholar 

  66. Kulle TJ, Cooper GP. Effects of formaldehyde and ozone on the trigeminal nasal sensory system. Arch Environ Health 1975;30:237–243.

    PubMed  CAS  Google Scholar 

  67. Blau JN, Solomon F. Smell and other sensory disturbances in migraine. J Neurol 1985;232:275,276.

    Article  PubMed  CAS  Google Scholar 

  68. Raffaelli E, Martins O. A role for anticonvulsants in migraine. Funct Neurol 1986; 1:495–498.

    Google Scholar 

  69. Hirsch AR. Olfaction in migraineurs. Headache 1992; 32:233–236.

    Article  PubMed  CAS  Google Scholar 

  70. Bruyn GW. Migraine equivalents. In: Vinken PJ, Bruyn GW, Klawans HL, eds., Handbooks of Clinical Neurology. New York: Elsevier, 1985: pp. 155–171.

    Google Scholar 

  71. Adams R, Victor M. Principles of neurology. New York, McGraw-Hill, 1989:183–189.

    Google Scholar 

  72. Skillern RH. The accessory sinuses of the nose. Philadelphia, J.B. Lippincott, 1913; p. 57,58.

    Google Scholar 

  73. Davidson JP. Indications for and method of operating upon the middle turbinated bone. Atlanta Journal-Record Medicine 1900;2:6–13.

    Google Scholar 

  74. Campbell JK, Sakai F. Migraine diagnosis and differential diagnosis. In: Olesen J, Tfelt-Hansen P, Welch KMA, eds., The Headaches. New York: Raven, 1993; p. 281.

    Google Scholar 

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Authors
  1. Dean M. Clerico MD
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Editors and Affiliations

  1. Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA

    M. Eric Gershwin MD  & Gary A. Incaudo MD  & 

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Clerico, D.M. (1996). Rhinopathic Headaches. In: Gershwin, M.E., Incaudo, G.A. (eds) Diseases of the Sinuses. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-0225-7_21

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  • DOI: https://doi.org/10.1007/978-1-4612-0225-7_21

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4612-6670-9

  • Online ISBN: 978-1-4612-0225-7

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