Journal List > J Rhinol > v.22(1) > 1044344

Jee, Lee, Hong, Jae, and Kim: Prospective Study on the Characteristics and Postoperative Improvement of Rhinogenic Headache

Abstract

Background and Objectives

Headache secondary to sinonasal disease can improve after surgery, but few prospective studies have investigated this outcome. We aimed to evaluate the characteristics of headaches, such as clinical features, underlying disease, and postoperative improvement in patients who underwent nasal surgery, and to identify the characteristics that reliably predict rhinogenic headache. Materials and Method: Of 356 patients who underwent nasal surgery between March and December 2009, 41 patients with headaches were enrolled in this prospective study. Clinical features of headache, such as onset, time of day, duration, frequency, nature, side and location, existence of aura, aggravating and relieving factors and accompanying nasal symptoms, underlying diseases, endoscopic findings, and computed tomography scans of the paranasal sinuses were evaluated. Headache intensity was graded based on a 10-point visual analog scale (VAS) pre- and post-operatively. Results: The most common characteristics of rhinogenic headache included a stabbing or squeezing nature, frontal area location, accompanying nasal obstruction or rhinorrhea, and underlying sinusitis or septal deviation. The subjective intensity of the headache, measured using the VAS score, improved in 80% (33/41) of the patients after surgery. Conclusion: Nasal surgery should be considered when rhinogenic headache is suspected and there are definite nasal pathologies.

References

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Fig. 1.
Pre-and post-operative visual analog scale score for headache in the resolved and improved groups (A) and in the no-change and worsened groups (B). *: p<0.05. VAS: visual analog scale, Preop: Preoperative, Post: Postoperative, wks: weeks, mon: months.
jr-22-6f1.tif
Table 1.
Underlying disease
  Number of patients Percentage (%)
Sinusitis 20 48.8
Sinusitis with DSN 12 29.3
DSN 8 19.5
ITH with synechia 1 2.4

DSN: Deviated nasal septum, ITH: Inferior turbinate hypertrophy

Table 2.
Clinical features of headache
Feature of headache Number of patients* Percentage (%)
Nature    
  Stabbing 12 29.3
  Squeezing 12 29.3
  Pulsating 10 24.4
  Dull 8 19.5
Location    
  Frontal 19 46.3
  Temporal 14 34.1
  Parietal 9 21.9
  Occipital 6 14.6
  Periorbital 4 9.8
Time of attack    
  Whole day 11 26.8
  Afternoon 11 26.8
  Morning 10 24.4
  Evening 10 24.4
  Sleep 0 0
Aggravating factor    
  Stress 15 36.6
  Routine daily activity 6 14.6
  Allergy 4 9.8
  Other 4 9.8
  Light 1 2.4
  Sound 0 0
  None 11 26.8
Accompanying symptom    
  Nasal obstruction 22 53.7
  Rhinorrhea 17 41.5
  Postnasal drip 14 34.1
  Facial pain/pressure 14 34.1
  Itching/sneezing 14 34.1
  Hyposmia 8 19.5
  Cough 5 12.2
  Fever 1 2.4

* Numbers are not mutually exclusive

Table 3.
Correlation between the side of the lesion and side of the headache
Lesion N* Same (%) Opposite (%) Not specific (%)
Sinusitis 32 21 (65.6) 1 (3.1) 10 (31.3)
Paradoxical middle turbinate 4 2 (50.0) 2 (50.0) 0 (0)
Concha bullosa 13 4 (30.8) 3 (23.1) 6 (46.1)
Septal deviation 31 6 (19.4) 6 (19.4) 19 (61.2)
Septal spur 25 2 (8.0) 7 (28.0) 16 (64.0)
Contact point 17 6 (35.3) 1 (5.9) 10 (58.8)

* Numbers are not mutually exclusive. N: number of patients

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