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Choi, Kim, Ryu, Lim, Song, and Yeo: Headache Characteristics in Rhinologic Patients and the Role of Surgical Treatment
Original Article

J Rhinol 2015;22(1):11-17.

Published online: 10 January 2015

DOI: https://doi.org/10.18787/jr.2015.22.1.11

Headache Characteristics in Rhinologic Patients and the Role of Surgical Treatment

Jae Won Choi, MD, Eung Ho Kim, MD, In Sun Ryu, MD, Hyun Woo Lim, MD, PhD, Yong Jin Song, MD, PhD, Nam-Kyung Yeo, MD, PhD

Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

Address for correspondence: Nam-Kyung Yeo, MD, PhD Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 415 Bangdonglee, Sachunmyun, Gangneung 210-711, Korea Tel: +82-33-610-3308, Fax: +82-33-610-4960 E-mail: newnew1@hanmail.net

Received 4 March 2015       Revised 23 April 2015       Accepted 21 May 2015

Copyright © 2015 Journal of Rhinology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

：Even though headache is a common symptom in patients with chronic rhinosinusitis (CRS) or nasal septal deviation (NSD), there are very few recent reports investigating headache characteristics in rhinologic patients. Therefore, we investigated the headache characteristics and differences in CRS and NSD patients who were diagnosed by computerized tomography and endoscopic exams. Methods： We enrolled 257 patients who had undergone nasal and sinus surgery between January 2012 and December 2013. The subjects were divided into a CRS group (n=147) and NSD group (n=110). They were asked to fill out a Sinonasal Outcome Test (SNOT-20) and questionnaire about pre-operation headaches (1 day prior) and post-operation headaches (1 month after) they experienced, to evaluate their sinonasal symptoms and headache characteristics. Results： There was no significant pre-operative difference in rhinologic symptoms and headache characteristics between the CRS and NSD groups. Females experienced more headaches. Both groups reported significant improvements to their headaches after surgery; however, we found no significant differences in the degree of improvement between the two groups. Conclusions： There was no significant difference in the headache characteristics and the degree of post-operative improvement between the CRS and NSD groups. Surgical treatments appear to reduce headaches in patients with rhinologic diseases.

Keywords: Headache, Chronic rhinosinusitis, Septal deviation, Sinus headache, Endoscopic sinus surgery, Septoplasty.

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Table 1.
Subject characteristics according to nasal disease
  CRS (n=147) NSD (n=110) p-value
Age (years) 46.77 32.41 ＜0.001*
  (Mean value)      
Sex      
  Female 38.1% 19.1% 0.001*
  Male 61.9% 80.9%
Pre-op SNOT-20 27.24 27.50 0.884*
  (Mean value, 0–100)      
Pre-op headache      
  No 61.2% 73.6% 0.037*
  Yes 38.8% 26.4%

* p-value＜0.05. Pre-op SNOT-20: pre-operative Sinonasal Outcome Test-20 total score, CRS: chronic rhinosinusitis, NSD: nasal septal deviation

Table 2.
Multivariable analysis of pre-operative headaches
  Odds ratio 95% confidence interval p-value
Nasal disease      
  NSD 1    
  CRS 1.819 0.972–3.406 0.061
Sex      
  Male 1    
  Female 2.658 1.475 – 4.792 0.001*
Age (years)      
  ＜30 1.831 0.845–3.968 0.125
  30–50 1.190 0.585–2.422 0.631
  ≥50 1   0.285
Pre-op SNOT-20 1.028 1.008–1.049 0.006*

* p-value＜0.05. Pre-op SNOT-20: pre-operative Sinonasal Outcome Test-20 total score, CRS: chronic rhinosinusitis, NSD: nasal septal deviation

Table 3.
Comparison of headache characteristics between CRS group and NSD group
Variables CRS (n=57) NSD (n=29) p-value
Intensity (VAS, 0–10) 4 5 0.677
Frequency of attacks     0.476
  Daily 11 (21.2%) 03 (11.5%)  
  1–3/week 22 (42.3%) 11 (42.3%)  
  1–3/month 16 (30.8%) 08 (30.8%)  
  < 1/month 03 (5.8%) 04 (15.4%)  
Duration of attacks (hours) 29 (50.9%) 14 (48.3%) 0.182
  < 3 11 (19.3%) 04 (13.8%)  
  3–4 08 (14.0%) 07 (24.1%)  
  4–24 00 02 (6.9%)  
  24–72 04 (7.0%) 02 (6.9%)  
  72–168 05 (8.8%) 00  
Time of attacks      
  Wake up 08 (14.0%) 05 (17.2%)  
  Morning 08 (14.0%) 04 (13.8%)  
  Afternoon 23 (40.4%) 09 (31.0%)  
  Evening 10 (17.5%) 04 (13.8%)  
  Bedtime 01 (1.8%) 01 (3.4%)  
  All day 06 (10.5%) 06 (20.7%)  
  Unknown 01 (1.8%) 00  
Characters of attacks     0.851
  Pulsating 22 (38.6%) 14 (48.3%)  
  Pressing/tightening 16 (28.1%) 06 (20.7%)  
  Fulgurating 08 (14.0%) 04 (13.8%)  
  Other 11 (19.3%) 05 (17.2%)  
Direction of attacks     0.864
  Right 09 (19.1%) 05 (22.7%)  
  Left 08 (17.0%) 02 (9.1%)  
  Both 18 (38.3%) 10 (45.5%)  
  Alternating 12 (25.5%) 05 (22.7%)  
Accompanying symptoms      
  Loud sound 04 (6.6%) 01 (2.9%)  
  Flashing light 00 01 (2.9%)  
  Nausea/vomiting 09 (14.8%) 05 (14.7%)  
  Diarrhea 00 01 (2.9%)  
  Nasal obstruction 19 (31.1%) 10 (29.4%)  
  Rhinorrhea 09 (14.8%) 03 (8.8%)  
  None 19 (31.1%) 13 (38.2%)  
Limitations to daily life      
  Work or studies 11 (19.3%) 12 (40.0%)  
  Housekeeping activity 06 (10.5%) 02 (6.7%)  
  Leisure activity 03 (5.3%) 01 (3.3%)  
  All activity 18 (31.6%) 07 (23.3%)  
  None 18 (31.6%) 08 (26.7%)  

CRS: chronic rhinosinusitis, NSD: nasal septal deviation, VAS: visual analogue scale

Table 4.
Relationship between headache locations and sinonasal lesions in patients with headaches
Direction of headache Right Left Both A Alternative
Direction of CRS (n=57)        
  Right 2 0 02 00
  Left 1 1 02 00
  Both 6 7 14 12
Direction of NSD (n=29)        
  Right 4 0 08 00
  Left 1 2 02 05

*: Ten patients of CRS and 2 patients of NSD didn’t check their headache locations. CRS: chronic rhinosinusitis, NSD: nasal septal deviation

Table 5.
Correlation coefficients between pre-operative head ache characteristics and pre-operative SNOT-20 in the chronic rhinosinusitis group (n=57)
Pre-op SNOT-20 Pre-operative headache characteristics
Intensity Frequency Duration
Total score      
  Correlation coefficient 0.198* –0.111 0.130*
  p-value 0.016* –0.189 0.115*
Rhinologic      
  Correlation coefficient 0.029* –0.013 –0.013*
  p-value 0.724* –0.878 0.877*
Ear/facial      
  Correlation coefficient 0.305* –0.248 0.239*
  p-value ＜0.001* –0.003* 0.004*
Sleep      
  Correlation coefficient 0.148* –0.065 0.086*
  p-value 0.074* –0.441 0.298*
Psychological      
  Correlation coefficient 0.167* –0.204 0.190*
  p-value 0.043* –0.015* 0.021*

* p-value＜0.05. Pre-op SNOT-20: pre-operative Sinonasal Out come Test-20 total score

Table 6.
Correlation Coefficient between pre-operative headache characteristics and pre-operative SNOT-20 in the nasal septal deviation group (n=29)
Pre-op SNOT-20 Pre-operative headache characteristics
Intensity Frequency Duration
Total score      
  Correlation coefficient 0.392* –0.375* 0.374*
  p-value ＜0.001* ＜0.001* ＜0.001*
Rhinologic      
  Correlation coefficient 0.139* –0.113* 0.148*
  p-value 0.147* 0.247* 0.123*
Ear/facial      
  Correlation coefficient 0.387* –0.347* 0.348*
  p-value ＜0.001* ＜0.001* ＜0.001*
Sleep      
  Correlation coefficient 0.283* –0.303* 0.298*
  p-value 0.003* 0.001* 0.002*
Psychological      
  Correlation coefficient 0.328* –0.285* 0.264*
  p-value ＜0.001* 0.003* 0.006*

* p-value＜0.05. Pre-op SNOT-20: pre-operative Sinonasal Outcome Test-20 total score

Table 7.
Correlation coefficient between pre-operative headache characteristics and Lund-Mackay CT score in the chronic rhinosinusitis group (n=57)
Pre-operative headache characteristics Correlation coefficient p-value
Intensity –0.010 0.903
Frequency –0.011 0.899
Duration –0.067 0.423
Table 8.
Comparison between pre-operative and 1-month post-operative mean score of headache characteristics according to nasal disease (%)
Questionnaire CRS (n=57) NSD (n=29) p-value*
Worse or no change (%) Better (%) Worse or no change (%) Better (%)
Headache          
  Intensity 15.8 84.2 13.8 86.2 1.000
  Frequency 22.4 77.6 19.2 80.8 0.746
  Duration 17.5 82.5 24.1 75.9 0.468

* p-value: for difference between CRS & NSD groups. CRS: chronic rhinosinusitis, NSD: nasal septal deviation

Table 9.
Comparison between pre-operative and 1-month post-operative mean score of headache characteristics according to nasal disease (mean value)
Questionnaire CRS (n=57) NSD (n=29) p-value‡
Pre-op Post-op 1 month p-value† Pre-op Post-op 1 month p-value†
Headache              
  Intensity 4.53 1.07 ＜0.001* 4.24 1.24 ＜0.001* 0.499
  Frequency 2.24 4.24 ＜0.001* 2.50 4.38 ＜0.001* 0.520
  Duration 2.19 0.51 ＜0.001* 2.10 0.72 ＜0.001* 0.530

A higher score indicates greater intensity and longer duration; a lower score indicates greater frequency.

* p-value＜0.05

† p-val-ue: for difference between pre-op & 1 month post-op

‡ p-value: for difference in improvement between CRS & NSD groups. CRS: chronic rhinosinusitis, NSD: nasal septal deviation, Pre-op: pre-operative mean value, Post-op 1 month: 1-month post-operative mean value

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