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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To conclude, the paper by Brown in this issue illustrates the value of considering sinusitis as a cause of refractory headache but more importantly illustrates the value of new approaches to diagnosis and management of this frustrating condition. We must be cautious to avoid overutilization of these techniques; in all likelihood only a small percentage of patients have "true sinus headaches." However, we should be liberal about using new imaging techniques (notably, CT scans) to determine which patients need thorough evaluation by an otolaryngologist. Although we have gained a great deal of information, one question still troubles me and remains largely unanswered. Why did the Good Lord see fit to give us sinuses in the first place?
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PMID:Sinusitis: more than a headache. 156 7

The endoscopic sinus surgery is probably the most exciting topics in rhinology. Not only is the technology new, but the approach to sinus disease has changed dramatically. In this paper, we tried to present how sinus endoscopy can be applied to the treatment of sinus diseases and more radical forms of sinus surgery. Three kinds of surgical procedures were performed, they were the functional anterior ethmoidectomy, total ethmoidectomy, and total sphenoethmoidectomy for treatment of chronic ethmoid sinusitis (2 cases), polysinusitis with polyps (16 cases), and pansinusitis with polyps (5 cases). The results showed that the pus disappeared in 14 cases (60.8%), the dizziness and headache improved in 22 cases (95%), the smell improved in 14 cases (70%). There were 4 complications: nasolacrimal duct injury in one, and lamina papyracea injury in three. All of them recovered after management.
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PMID:[Transnasal endoscopic sinus surgery]. 193 Nov 80

Nasal endoscopic examination and CT views of the sinuses were obtained in patients with symptoms of headache and sinusitis who had failed to respond to conservative medical therapy. Endoscopic sinus surgery has challenged traditional concepts of sinus disease management. The site of obstruction rather than the extent of the disease is the major concern. Removal of pressure points with reestablishment of a competent airway, and revision of sinus passageways to facilitate mucociliary drainage and ventilation of the obstructed cavity can benefit patients with chronic headaches.
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PMID:Sinusitis and headache. 194 25

Seventy-four verified cases of cerebral abscess seen in the Regional Neurosurgical Centre at Addenbrookes Hospital, Cambridge between 1965 and 1987 were reviewed. During that time no decline in incidence or change in the associated mortality was found to occur. ENT disease, taken as a whole, represented the most common source (40%) while acute frontal sinusitis (23%) proved to be the most common single underlying cause. Cerebral abscesses of sinogenic origin in particular were diagnosed late, with a deteriorating conscious level being the precipitating event in 94% of cases. Over 80% of such patients had presented initially to a non-ENT department with acute frontal headache where neither the underlying frontal sinusitis nor the developing intracranial complication had been suspected. These findings might explain why the incidence and mortality associated with cerebral abscesses of sinogenic origin, have changed little in the last 25 years despite improvements in diagnostic imaging, surgical technique and antibiotic therapy. We recommend that the diagnosis of acute frontal sinusitis be considered in any patient who presents with acute frontal headache, particularly if symptoms are unilateral. Furthermore, we stress that early confirmation of intracerebral complications by computerized axial tomography (CT) scanning continues to depend entirely upon an early clinical diagnosis which should result from a high level of clinical suspicion in patients who develop intracranial symptoms in the presence of known acute frontal sinus infection.
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PMID:Persisting incidence and mortality of sinogenic cerebral abscess: a continuing reflection of late clinical diagnosis. 202 39

About half of the aneurysm patients admitted to neurosurgical departments experience warning symptoms in the form of minor bleeding episodes days or even several months before a major haemorrhage occurs. Headache is the most common symptom of this warning leak, occurring in 9 out of 10 patients. The onset of headache is sudden and is unusual in severity and location, being unlike any headache the patient has otherwise experienced. It is frequently accompanied by transient nausea, vomiting, visual disturbances or meningism. Medical advice may be sought by the patient but all too often the diagnostic importance of a warning headache is missed. It is misinterpreted as attacks of migraine, tension headache, the 'flu, sinusitis, or a "sprained neck". A more vigilant attention to the presence of a warning headache probably offers the greatest opportunity for altering the otherwise serious natural history of aneurysmal subarachnoid haemorrhage. If a warning headache is suspected, lumbar puncture is the examination of choice, once CT scanning has ruled out an intracranial mass lesion.
Cephalalgia 1991 Feb
PMID:Headache as a warning symptom of impending aneurysmal subarachnoid haemorrhage. 203 71

AIDS patients suffer from multiple immunologic deficits involving humoral and cell-mediated immunity. The humoral deficits place the patient at a higher risk for recurrent bacterial infection than the general population. Sinusitis has been recognized to be a more common problem in AIDS patients than was previously appreciated. A high level of clinical suspicion is important, especially in patients with fever, headaches, or symptoms referrable to the upper respiratory tract. Should sinusitis be demonstrated, aggressive medical management is indicated. Surgical drainage is indicated in patients who worsen in spite of appropriate medical therapy, patients who have signs of systemic toxicity from the sinusitis that do not rapidly improve, and patients with recurrent sinusitis. Further studies are indicated to determine the true incidence of sinusitis in the AIDS population and to elucidate further the immunologic defects involved.
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PMID:Sinusitis in patients with the acquired immunodeficiency syndrome. 220 70

The role of nasal allergy in chronic maxillary sinusitis without an air-fluid level was studied in 37 patients. Seventy-three nasal provocation tests with various inhalant allergens were performed in 37 patients by means of rhinomanometry, and maxillary sinus radiographs were performed before and repeatedly after the allergen challenge. Forty-one positive nasal responses (NRs) occurred in 29 patients; 13 were immediate only, 18 were late only, and 10 NRs were dual responses. Of these responses, 32 demonstrated radiographic changes, primarily an increase in mucosal edema and/or opacification. These responses were accompanied by increased pressure in the maxillary sinuses, acute headache, and sometimes otalgia. Eight patients did not develop any NRs; however, increased thickening of the mucosal membrane of the maxillary sinuses, accompanied by subjective symptoms, was recorded in three of these nonresponders. These results demonstrate the role of nasal allergy in some patients with chronic maxillary sinusitis, which may affect the diagnostic and therapeutic approaches to this disorder.
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PMID:Role of nasal allergy in chronic maxillary sinusitis--diagnostic value of nasal challenge with allergen. 222 10

We present a case of sphenoid sinusitis resulting in a debilitating headache refractory to both oral and intramuscular analgesics. Despite an aggressive evaluation in the emergency department, the correct diagnosis and appropriate treatment were delayed. Recognition of sphenoid sinusitis, the complications associated with it, and the need for aggressive management are addressed.
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PMID:Sphenoid sinusitis, a cause of debilitating headache. 225 1

Depending on the pathologic process, the treatment of frontal sinus disease has consisted of obliteration or ablation of the sinus, or restoration of drainage into the nose. Intranasal endoscopic enlargement of the frontal recess and ostium, and removal of disease from the medial aspect of the frontal sinus offers a minimally invasive alternative to previous operations in selected patients. To better understand the indications, limitations, and potential problems with this operation, our experience with endoscopic frontal sinustomy in 36 patients over a 30-month period is reported. During the follow-up period, 21 patients had complete resolution of all symptoms, 11 patients were improved but had at least one episode of sinusitis or headache postoperatively, and 3 patients were worse, 2 of whom required frontal sinus obliteration for control of disease. Although endoscopic frontal sinusotomy appears to be a useful alternative to traditional frontal sinus procedures in selected patients, the reader is cautioned that such surgery is technically difficult and has not yet stood the test of time required of any frontal sinus operation.
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PMID:Endoscopic management of frontal sinus disease. 229 57

Forty-six of 152 consecutive adult rhinitis patients had perennial nonallergic rhinitis (PNR). Eighty-five percent of those with PNR presented with nasal congestion, whereas 15% presented with rhinorrhea. Their mean age was 40.5 years (range = 21-77), and 74% were female. Patients with perennial nonallergic rhinitis in this series were characterized by ocular pruritus or burning, 28%; frontal headache, 22%; symptoms consistent with asthma, 33%; an unremarkable nasal mucosa, 96%; the absence of nasal polyps, 100%; nasal eosinophilia (greater than or equal to 5%), 10%; nasal neutrophilia (greater than or equal to 25%), 22%; numerous nasal bacteria, 12%; sinusitis, 6%; and a geometric mean IgE of 26.4 U/mL. This experience suggests that PNR is a common problem in a general allergy practice. Nasal obstruction, usually more difficult to treat than rhinorrhea, is the dominant symptom. Unexpected findings were frequent conjunctivitis and nasal neutrophilia.
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PMID:Perennial nonallergic rhinitis: a retrospective review. 248 Jul 28


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