Skip to main content
SpringerLink
Log in

Sinus Headache and Rhinogenic Headache

  • Chapter
  • First Online:
Sinus Headache, Migraine, and the Otolaryngologist

  • 802 Accesses

Abstract

Sinus headache and rhinogenic headache are terms that were once used interchangeably. Studies over the last 15 years have shown that most “sinus headaches” are actually migraine, and that true rhinogenic headaches are relatively rare. Regardless, the appropriate diagnosis and treatment of these challenging patients remains controversial. This chapter will review the scientific literature regarding diagnosis and surgical intervention in these patients, and will provide a practical guide for incorporating this information in clinical otolaryngology and allergy practices.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. Arch Intern Med. 2004;164:1769–72.

    Article  PubMed  Google Scholar 

  2. Mehle ME, Schreiber C. Sinus headache, migraine, and the otolaryngologist. Otolaryngol Head Neck Surg. 2005;133:489–96.

    Article  PubMed  Google Scholar 

  3. Eross E, Dodick D, Eross M. The sinus, allergy and migraine study. Headache. 2007;47:213–24.

    Article  PubMed  Google Scholar 

  4. Mehle ME. What do we know about rhinogenic headache? Otolaryngologic Clin N Amer. 2014;47:255–68.

    Article  Google Scholar 

  5. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders, 3rd Ed. (Beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  6. Patel ZM, Kennedy DW, Setzen M, Poetker DM, DelGaudioJM. “Sinus headache”: rhinogenic headache or migraine? An evidence-based guide to diagnosis and treatment. Int Forum Allergy Rhinol. 2013;3:221–230.

    Google Scholar 

  7. Lal D, Rounds A, Dodick DW. Comprehensive management of patients presenting to the otolaryngologist for sinus pressure, pain, or headache. Laryngoscope. 2015;125:303–10.

    Article  PubMed  Google Scholar 

  8. Charleston L, Strabbing R, Cooper W. Is sinus disease the cause of my headaches? An update on sinus disease and headache. Curr Pain Headache Rep. 2014;18:418.

    Article  PubMed  Google Scholar 

  9. Paff GH. Anatomy of the head and neck. Philadelphia: W.B.Saunders; 1973.

    Google Scholar 

  10. Hollinshead WH. Anatomy for surgeons: the head and neck. Philadelphia: Harper and Row; 1982.

    Google Scholar 

  11. Sessle BJ. Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates. Crit Rev Oral Biol Med. 2000;11:57–91.

    Article  CAS  PubMed  Google Scholar 

  12. Baraniuk JN. Neurogenic mechanisms in rhinosinusitis. Current Allergy Asthma Reports. 2001;1:252–61.

    Article  CAS  PubMed  Google Scholar 

  13. Clerico DM. An experimental study of pain upon stimulation of the nasal and sinus cavities. Am J Otolaryngol-Head and Neck Med and Surg. 2014;. doi:10.1016/j.amjoto.2014.02.009.

    Google Scholar 

  14. Wolff HG. The nasal, paranasal, and aural structures as sources of headache and other pain. In: Headache and other head pain. New York: Oxford University Press; 1948. p. 532–560.

    Google Scholar 

  15. Abu-bakra M, Jones NS. Does stimulation of nasal mucosa cause referred pain to the face? Clin Otolaryngol. 2001;26:430–2.

    Article  CAS  PubMed  Google Scholar 

  16. Baraniuk JN, Lundgren JD, Okayama M, et al. Substance P and neurokinin A in human nasal mucosa. Am J Respir Cell Mol Biol. 1991;4:228–36.

    Article  CAS  PubMed  Google Scholar 

  17. Ivanusic JJ, Kwok MMK, Ahn AH, Jennings EA. 5-ht1d receptor immunoreactivity in the sphenopalatine ganglion: implications for the efficacy of triptans in the treatment of autonomic signs associated with cluster headache. Headache. 2011;51(3):392–402.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mehle ME. Migraine and allergy: a review and clinical update. Curr Allergy Asthma Rep. 2012;. doi:10.1007/s11882-012-0251-x.

    PubMed  Google Scholar 

  19. Bellamy J, Cady R, Durham P. Salivary levels of cgrp and vip in rhinosinusitis and migraine patients. Headache. 2006;46:24–33.

    Article  PubMed  Google Scholar 

  20. Gelfand EW. Inflammatory mediators in allergic rhinitis. J Allergy Clin Immunol. 2004;114:s135–8.

    Article  PubMed  Google Scholar 

  21. Mehle ME, Kremer PS. Sinus CT scan findings in “sinus headache” migraineurs. Headache. 2008;48:67–71.

    PubMed  Google Scholar 

  22. Behin F, Lipton RB, Bigal M. Migraine and intranasal contact point headache: is there any connection? Curr Pain Headache Rep. 2006;10:312–5.

    Article  PubMed  Google Scholar 

  23. Arslan HH, Tokgoz E, Yildizoglu U, Durmaz A, Bek S, Gerek M. Evaluation of the changes in the nasal cavity during the migraine attack. J Craniofac Surg. 2014;25(5):e446–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Orlandi RR, Kingdom TT, Hwang PH, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016;6:s22–209.

    Article  PubMed  Google Scholar 

  25. Lal D, Rounds AB, Rank MA, Divekar R. Clinical and 22-item sino-nasal outcome test symptom patterns in primary headache disorder patients presenting to otolaryngologists with “sinus” headaches. Int Forum Allergy Rhinol. 2015;5:408–16.

    Article  PubMed  Google Scholar 

  26. Aaseth K, Grande RB, Kvaerner K, Lundqvist C, Russel MB. Chronic rhinosinusitis gives a ninefold increased risk of chronic headache. The akershus study of chronic headache. Cephalgia. 2010;30(2):152–160.

    Google Scholar 

  27. Jones NS, Strobl A, Holland I. CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol. 1997;22:47–51.

    Article  CAS  PubMed  Google Scholar 

  28. Shields G, Seikaly H, LeBoeuf M, et al. Correlation between facial pain or headache and computed tomography in rhinosinusitis in Canadian and US subjects. Laryngoscope. 2003;113:943–5.

    Article  PubMed  Google Scholar 

  29. Tarabichi M. Characteristics of sinus-related pain. Otolaryngol Head Neck Surg. 2000;122:842–7.

    Article  CAS  PubMed  Google Scholar 

  30. Kenny TJ, Duncavage J, Bracikowski J, et al. Prospective analysis of sinus symptoms and correlation with paranasal computed tomography scan. Otolaryngol Head Neck Surg. 2001;125:40–3.

    Article  CAS  PubMed  Google Scholar 

  31. Bhattacharyya T, Piccirillo J, Wippold FJ. Relationship between patient-based descriptions of sinusitis and paranasal sinus computed tomographic findings. Arch Otolaryngol Head Neck Surg. 1997;123:1189–92.

    Article  CAS  PubMed  Google Scholar 

  32. Anzai Y, Weymuller EA, Yueh B, et al. The impact of sinus computed tomography on treatment decisions for chronic sinusitis. Arch Otolaryngol Head Neck Surg. 2004;130:423–8.

    Article  PubMed  Google Scholar 

  33. Arango P, Kountakis S. Significance of computed tomography pathology in chronic sinusitis. Laryngoscope. 2001;111:1779–82.

    Article  CAS  PubMed  Google Scholar 

  34. Stankiewicz JA. Endoscopic and imaging techniques in the diagnosis of chronic rhinosinusitis. Current All Asthma Rep. 2003;3:519–22.

    Article  Google Scholar 

  35. Stankiewicz JA, Chow JM. Cost analysis in the diagnosis of chronic rhinosinusitis. Am J Rhinology. 2003;17:139–42.

    Google Scholar 

  36. Jackson A, Dial A. Sinus headache in an ENT setting. Poster presented at the American Academy Neurology Annual Meeting, 9–16 April 2004. Miami, Florida.

    Google Scholar 

  37. Tan BK, Chandra RK, Pollak J, et al. Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2013;131:1350–60.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hsueh WD, Conley DB, Kim H, et al. Identifying clinical symptoms for improving the symptomatic diagnosis of chronic sinusitis. Int Forum Allergy Rhinol. 2013;3:307–14.

    Article  PubMed  Google Scholar 

  39. Cady RK, Schreiber CP. Sinus problems as a cause of headache refractoriness and migraine chronification. Curr Pain Headache Rep. 2009;13:319–25.

    Article  PubMed  Google Scholar 

  40. Perry BF, Login IS, Kountakis SE. Nonrhinologic headache in a tertiary rhinology practice. Otolaryngol Head Neck Surg. 2004;130:449–52.

    Article  PubMed  Google Scholar 

  41. Wartoloska K, Judge A, Hopewell S, Collins GS, Dean BJF, Rombach I, et al. Use of placebo controls in the evaluation of surgery: systematic review. BMJ. 2014;348:g3253.

    Article  Google Scholar 

  42. deCraen AJM, Tijssen JGP, deGans J, Kleijnen J. Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos. J Neurol. 2000;247:183–188.

    Google Scholar 

  43. Meissner K, Fassler M, Ruckner G, KleijnenJ Hrobjartsson A, Schneider A, et al. Differential effectiveness of placebo treatments a systematic review of migraine prophylaxis. JAMA Intern Med. 2013;173(21):1941–51.

    Article  PubMed  Google Scholar 

  44. Holtedahl R, Brox JI, Tjolmsland O. Placebo effects in trials evaluating 12 selected minimally invasive interventions: a systematic review and meta-analysis. BMJ Open. 2015;5:e007331.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Ernst E, Resch KL. Concept of true and perceived placebo effects. BMJ. 1995;311:551–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Harrison L, Jones NS. Intranasal contact points as a cause of facial pain or headache: a systematic review. Clin Otolaryngol. 2013;38:8–22.

    Article  CAS  PubMed  Google Scholar 

  47. Colloca L, Grillon C. Understanding placebo and nocebo responses for pain management. Curr Pain Headache Rep. 2014;18(6):419.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Homer JJ, Sheard CE, Jones NS. Cognitive dissonance, the placebo effect and the evaluation of surgical results. Clin Otolaryngol. 2000;25:195–9.

    Article  CAS  PubMed  Google Scholar 

  49. Soler ZM, Mace J, Smith TL. Symptom-based presentation of chronic rhinosinusitis and symptom-specific outcomes after endoscopic sinus surgery. Am J Rhinol. 2008;22:297–301.

    Article  PubMed  Google Scholar 

  50. Chester AC, Antisdel JL, Sindwani R. Symptom-specific outcomes of endoscopic sinus surgery: a systematic review. Oto Head Neck Surg. 2009;140:633–9.

    Article  Google Scholar 

  51. Chow JM. Rhinologic headaches. Otolaryngol Head Neck Surg. 1994;111:211–8.

    Article  CAS  PubMed  Google Scholar 

  52. Clerico DM, Evan K, Montgomery L, Lanza DC, Grabo D. Endoscopic sinonasal surgery in the management of primary headaches. Rhinology. 1997;35:98–102.

    CAS  PubMed  Google Scholar 

  53. Parsons DS, Batra PS. Functional endoscopic sinus surgical outcomes for contact point headaches. Laryngoscope. 1998;108:696–702.

    Article  CAS  PubMed  Google Scholar 

  54. Ramadan HH. Nonsurgical versus endoscopic sinonasal surgery for rhinogenic headache. Am J Rhinol. 1999;13:455–7.

    Article  CAS  PubMed  Google Scholar 

  55. Tarabichi M. Characteristics of sinus-related pain. Otolaryngol Head Neck Surg. 2000;122:842–7.

    Article  CAS  PubMed  Google Scholar 

  56. Giacomini PG, Alessandrini M, DePadova A. Septoturbinal surgery in contact point headache syndrome: long-term results. J Craniomandib Prac. 2003;21(2):130–5.

    Google Scholar 

  57. Levine HL, Clemente MP. Sinus surgery: endoscopic and microscopic approaches. New York: Thieme; 2005. p. 132–40.

    Google Scholar 

  58. Moretz W, Kountakis S. Subjective headache before and after sinus surgery. Am J Rhinol. 2006;20:305–7.

    Google Scholar 

  59. Phillips JS, Vowler SL, Salam MA. Endoscopic sinus surgery for sinus headache. Rhinology. 2007;45:14–9.

    CAS  PubMed  Google Scholar 

  60. Ahamed SH, Jones NS. What is sluder’s neuralgia? J Laryngol Otol. 2003;117:437–43.

    Article  CAS  PubMed  Google Scholar 

  61. Abu-bakra M, Jones NS. Does stimulation of nasal mucosa cause referred pain to the face? Clin Otolaryngol. 2001;26:430–2.

    Article  CAS  PubMed  Google Scholar 

  62. Bieger-Farhan AK, Nichani J, Willat DJ. Nasal septal contact points: associated symptoms and sinus CT scan scoring. Clin Otolaryngol Alled Sci. 2004;29:165–8.

    Article  CAS  Google Scholar 

  63. Mariotti LJ, Setliff RC, Ghaderi M, et al. Patient history and CT findings in predicting surgical outcomes for patients with rhinogenic headache. ENT J. 2009;88:926–9.

    Google Scholar 

  64. Goldsmith AJ, Zahtz GD, Stegnjajic A, et al. Middle turbinate headache syndrome. Am J Rhinol. 1993;7:17–23.

    Article  Google Scholar 

  65. Abu-Samra M, Gawad OA, Agha M. The outcomes for nasal contact point surgeries in patients with unsatisfactory response to chronic daily headache medications. Eur Arch Otorhinolaryngol. 2011;268:1299–304.

    Article  PubMed  Google Scholar 

  66. Novak VJ, Makek M. Pethogenesis and surgical treatment of migraine and neurovascular headaches with rhinogenic trigger. Head Neck. 1992;14:467–72.

    Article  CAS  PubMed  Google Scholar 

  67. Tosun F1, Gerek M, Ozkaptan Y. Nasal surgery for contact point headaches. Headache. 2000;40(3):237–40.

    Google Scholar 

  68. Sindwani R, Wright ED. Role of endoscopic septoplasty in the treatment of atypical facial pain. J Otolaryngol. 2003;32:77–80.

    Article  PubMed  Google Scholar 

  69. Welge-Luessen A, Hauser R, Schmid N, Kappos L, Probst R. Endonasal surgery for contact point headaches: a 10-year longitudinal study. Laryngoscope. 2003;113:2151–6.

    Article  PubMed  Google Scholar 

  70. Behin F, Behin B, Behin D, Baredes S. Surgical management of contact point headaches. Headache. 2005;45:204–10.

    Article  PubMed  Google Scholar 

  71. Mokbel KM, Abd Elfattah AM, Kamal E. Nasal mucosal contact points with facial pain and/or headache: lidocaine can predict the result the result of localized endoscopic resection. Eur Arch Otorhinolaryngol. 2010;267:1569–72.

    Article  PubMed  Google Scholar 

  72. Bektas D, Alioglu Z, Akyol N, et al. Surgical outcomes for rhinogenic contact point headaches. Med Princ Pract. 2011;20:29–33.

    Article  PubMed  Google Scholar 

  73. Mohebbi A, Memari F, Mohebbi S. Endonasal endoscopic management of contact point headache and diagnostic criteria. Headache. 2010;50:242–8.

    Article  PubMed  Google Scholar 

  74. Yazici ZM, Cabalar M, Sayin I, et al. Rhinologic evaluation in patients with primary headache. J Craniofac Surg. 2010;21:1688–91.

    Article  PubMed  Google Scholar 

  75. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. 1991;101:56–64.

    CAS  Google Scholar 

  76. Roozbahany NA, Nasri S. Nasal and paranasal sinus anatomic variations in patients with rhinogenic contact point headache. Auris Nasus Larynx. 2013;40:177–83.

    Article  PubMed  Google Scholar 

  77. San T, San S, Gurkan E, Erdogan B. The role of septated concha bullosa on sinonasal pathologies. Eur Arch Otorhinolaryngol. 2015;272:1417–21.

    Article  PubMed  Google Scholar 

  78. Cantone E, Castagna G, Ferranti I, Cimmino M, Sicignano S, Rega F, et al. Concha bullosa related headache disability. Eur Rev Med Pharmacol Sci. 2014;19:2327–30.

    Google Scholar 

  79. Kunachak S. Middle turbinate lateralization: a simple treatment for rhinologic headache. Laryngoscope. 2002;112:870–2.

    Article  PubMed  Google Scholar 

  80. Sanges G, Feleppa M, Gamerra M, et al. Curr Pain Headache Rep 2011; doi:10.1007/s11916-011-0194-2.

  81. Yarmohammadi ME, Ghasemi H, Pourfarzam S, Nadoushan MRJ, Majd SA. Effect of turbinoplasty in concha bullosa induced rhinogenic headache, a randomized clinical trial. J Res Med Sci. 2012;17(3):229–34.

    PubMed  PubMed Central  Google Scholar 

  82. Anselmo-Lima WT, deOliveira JAA, Speciali JG, Bordini C, dosSantos AC, Rocha KV, et al. Middle turbinate headache syndrome. Headache. 1997;37:102–6.

    Article  CAS  PubMed  Google Scholar 

  83. Guyuron B, Reed D, Kriegler JS, et al. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg. 2009;124:461–8.

    Article  CAS  PubMed  Google Scholar 

  84. Guyuron B, Kriegler JS, Davis J, et al. Five-year outcome of surgical treatment of migraine headaches. Plast Reconstr Surg. 2011;127:603–8.

    Article  CAS  PubMed  Google Scholar 

  85. Herzallah IR, Hamed MA, Salem SM, Suurna MV. Mucosal contact points and paranasal sinus pneumatization: does radiology predict headache causality? Laryngoscope. 2015;. doi:10.1002/lary.25194.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy, Northeast Ohio Medical University, 4209 St. Rt. 44, Rootstown, OH, 44272, USA

    Mark E. Mehle

  2. Private Practice, ENT and Allergy Health Services, North Olmsted, OH, 44070, USA

    Mark E. Mehle

Authors
  1. Mark E. Mehle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark E. Mehle .

Editor information

Editors and Affiliations

  1. E.N.T. & Allergy Health Services , North Olmsted, Ohio, USA

    Mark E. Mehle

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Mehle, M.E. (2017). Sinus Headache and Rhinogenic Headache. In: Mehle, M. (eds) Sinus Headache, Migraine, and the Otolaryngologist. Springer, Cham. https://doi.org/10.1007/978-3-319-50376-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-50376-9_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50375-2

  • Online ISBN: 978-3-319-50376-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation