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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.
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 |
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 |
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) |
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