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

Headache associated with acute sinusitis is a well-recognized entity; the diagnosis is easily made due to the associated nasal and sinus symptoms. However, the phenomenon of referred headache from chronic sinusitis or intranasal abnormalities or both without upper respiratory symptoms is not well understood. Only recently have the nasal and sinus cavities been adequately visualized by both the human eye and radiographic techniques; a fact that may account for the historic neglect in considering this region a factor in headache etiology. Modern techniques employed in the workup of sinusitis, namely the use of rigid nasal endoscopes and coronal-plane CT scanning, have greatly enhanced the clinician's ability to evaluate and diagnose pathology in this area. This report describes a series of patients presenting with various primary headache syndromes without significant nasal or sinus symptoms who failed to respond to conventional antiheadache therapy. On nasal endoscopic and coronal CT examinations, various intranasal and sinus abnormalities were found (either anatomic variations or subclinical inflammation). Medical and/or surgical therapy addressing the sinonasal pathology resulted in improvement in every case, ranging from decreased severity of attacks to total resolution of headaches. A model explaining the possible mechanism of referred vascular-type headache from sinus and nasal origin is proposed.
Headache 1995 Apr
PMID:Sinus headaches reconsidered: referred cephalgia of rhinologic origin masquerading as refractory primary headaches. 777 73

To demonstrate the typical clinical and CT features of sinonasal polyposis, we reviewed the clinical records and preoperative direct coronal CT scans of 35 patients with surgically proven disease. Symptoms included progressive nasal stuffiness (100%), rhinorrhea (69%), facial pain (60%), headache (43%) and anosmia (17%). We found associations with rhinitis (46%), asthma (29%) and aspirin sensitivity (9%). Coronal CT features included polypoid masses in the nasal cavity (91%), partial or complete pansinus opacification (90%), enlargement of infundibula (89%), bony attenuation of the ethmoid trabeculae (63%) and nasal septum (37%), opacified ethmoid sinuses with convex lateral walls (51%) and air-fluid levels (43%). The latter feature correlated with symptoms and signs of acute sinusitis in only 40% of patients. Recognition of sinonasal polyposis is important to the endoscopic surgeon since it can be the most troubling sinonasal inflammatory disease to manage due to its aggressive nature and tendency to recur despite appropriate treatment.
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PMID:Sinonasal polyposis: investigation by direct coronal CT. 799 Oct 94

In two ear, nose and throat (ENT) divisions, 74 patients affected by acute sinusitis of bacterial origin were selected and, after randomization in two balanced groups following an open parallel group design, assigned to treatment with brodimorprim and roxithromycin. At the beginning, after 3 days, 7 days and at the end of treatment the following symptoms were evaluated, using a four-step score: intensity of facial pain, headache, nasal stiffness, hyposmia, nasal secretion. The mean treatment period was 8.7 days. Tolerability was evaluated through registration and analysis of side effects and laboratory blood tests. The comparison between groups showed a better activity of brodimoprim on facial pain, headache, nasal stiffness and nasal secretion. The presence of resistant bacterial strains was greater in the group treated with roxithromycin (30.8%) when compared with the brodimoprim group (12.5%). Side effects were reported in 5 patients treated with brodimoprim and in 3 patients in the control group. Lab tests did not show serious variations.
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PMID:Efficacy and tolerability of brodimoprim and roxithromycin in acute sinusitis of bacterial origin in adults. 819 49

The clinical presentation, radiological and laboratory evaluation, treatment, and risk factors of sinusitis in a cohort of 376 human immunodeficiency virus (HIV)-infected children from a placebo-controlled clinical trial of intravenous immunoglobulin (IVIG) as prophylaxis for infections were examined. Ninety-five episodes of sinusitis were described in 60 patients; one-third of the patients had two or more episodes. Sinusitis episodes were commonly associated with nonspecific, chronic symptoms (67.4%, persistent nasal discharge; 54.7%, nocturnal or persistent cough), whereas symptoms more specific to acute sinusitis were less frequent (17.9%, headache or facial pain; 9.5%, periorbital swelling; 25.3%, temperature of > or = 102 degrees F; 9%, total white blood cell count of > or = 15,000/mm3). The sinuses primarily involved were the maxillary sinus (85.9%) and the ethmoidal sinus (42.3%); 36% of episodes involved two or more sinuses. Preceding respiratory infections did not appear to increase the risk of sinusitis, and CD4+ lymphocyte counts in children with and without sinusitis did not differ. Neither monthly IVIG prophylaxis nor three times weekly trimethoprimsulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia decreased the risk of sinusitis. Sinusitis in HIV-infected children is most often subacute and recurrent. Evaluations of new modalities for prophylaxis for sinusitis are needed.
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PMID:Sinusitis in children infected with human immunodeficiency virus: clinical characteristics, risk factors, and prophylaxis. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. 858 39

A 41-year-old truck driver had acute onset of weakness, severe headache and pain over the left side of the face, forehead, and orbital area. He was found to have acute pansinusitis. Blood cultures and culture of the sinus drainage yielded beta-hemolytic group C streptococcus: Streptococcus milleri. He recovered completely after treatment with cefazolin, surgical drainage and debridement, and outpatient cephalexin therapy. Beta-hemolytic streptococci are uncommon causes, and bacteremia is rare in acute sinusitis. Speciation of the streptococcus is important in determining the epidemiology and clinical spectrum of streptococcal infections.
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PMID:Acute pansinusitis with bacteremia due to a beta-hemolytic group C streptococcus: Streptococcus milleri. 940 16

Acute sinusitis frequently follows upper respiratory tract infections. Patients complain of headache, facial pain, fever and purulent rhinorrhoea. Diagnosis is based upon the symptoms, and treatment comprises symptomatic relief with analgesics, topical or systemic decongestants and steam inhalation. If indicated, antibiotics should be given for an adequate period of time. Patients with chronic sinusitis complain of a combination of nasal obstruction, rhinorrhoea and postnasal drip associated with intermittent facial pain, with symptoms persisting for 3 months or more. Predisposition to the condition may be caused by rhinitis (allergic or nonallergic) and anatomical variants. Failure of mucociliary transport and sinus ostial obstruction leads to mucosal oedema, mucous hypersecretion and chronic infection. Current treatment aims are to control rhinitis and improve ventilation and function of the sinuses. Rhinitis may be controlled with the long term use of topical corticosteroids, mast cell stabilisers or antihistamines, either alone or in combination. Secretions may be cleared with steam inhalation and/or saline nasal douching. Failure to control chronic sinusitis with medical treatment may indicate surgery. The aim of surgery is to improve ventilation and facilitate drainage of the sinuses, allowing the restoration of normal function. Removal of nasal polyps, reduction of inferior turbinates or septal straightening may be all that is required. Some patients will need endoscopic ethmoidectomy and middle meatal antrostomy. Improved ventilation in the ethmoid infundibulum may help to resolve disease in maxillary and frontal sinuses. Medical treatment of underlying rhinitis will need to be continued postoperatively, often in the long term, while special consideration needs to be paid to sinusitis in children, in relation to dental disease and in the immunosuppressed. Complications of acute and chronic sinusitis include intraorbital and intracranial sepsis. These potentially lethal complications need urgent evaluation with high resolution computerised tomography (CT) scanning, intravenous administration of broad spectrum antibiotics (including anaerobic and microaerophilic cover) and urgent surgical drainage as appropriate.
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PMID:Recognition and management of sinusitis. 966 99

In a primary care setting, the efficacy and safety of ciprofloxacin (CIP) 500 mg b.i.d. were compared with those of cefuroxime axetil (CA) 250 mg b.i.d., each given for 10 days, in a nationwide, open, prospective, randomized trial of 1414 adults with acute sinusitis. Patients were enrolled if they had clinically documented acute sinusitis (ie, rhinosinusitis) (<4 weeks' duration), based on the 1997 American Academy of Otorhinolaryngology--Head and Neck Surgery criteria of either two major or one major and two minor symptoms. The primary efficacy variable was clinical response (resolution or failure) at the posttherapy assessment on study days 14 through 26. The most common presenting major signs and symptoms of acute rhinosinusitis were facial congestion, nasal drainage/purulence, facial pain/pressure, and nasal obstruction/blockage. The minor symptom, headache, was more common and severe than was nasal obstruction/blockage. A total of 1219 patients were clinically evaluable. Clinical resolution was observed in 559 of 613 (91.2%) CIP-treated patients and 546 of 606 (90. 1%) CA-treated patients. The two regimens were statistically equivalent (95% confidence interval, -2.16% to 4.71%). There were 80 drug-related adverse events reported in the CIP-treated patients and 81 drug-related adverse events reported in the CA-treated patients. The main adverse events were nausea (n = 18) and diarrhea (n = 7) in patients treated with CIP and diarrhea (n = 14), nausea (n = 12), headache (n = 7), and vaginitis (n = 7) in those treated with CA. CIP 500 mg b.i.d. was found to be statistically equivalent to CA 250 mg b.i.d. in the treatment of acute rhinosinusitis.
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PMID:Multicenter comparative trial of ciprofloxacin versus cefuroxime axetil in the treatment of acute rhinosinusitis in a primary care setting. Rhinosinusitis Investigation Group. 982 44

This multicenter, randomized, double-blind trial compared the efficacy and safety of ciprofloxacin (CIP; 500 mg twice daily for 10 days, placebo for 4 days) to those of clarithromycin (CLARI; 500 mg twice daily for 14 days) in 560 adults with clinically documented and radiologically confirmed acute sinusitis. Of 457 efficacy-valid adults (236 CIP, 221 CLARI), clinical resolution plus improvement at the end of therapy was 84% for CIP-treated patients compared to 91% of CLARI recipients (CI95 = -0.131, -0.013). At the 1-month follow-up, more than twice as many CLARI-treated patients, 18 (10%), experienced a relapse, compared to 7 (4%) CIP-treated patients. The combined clinical response analyses (end of therapy and 1 -month follow-up) demonstrated that CIP and CLARI were statistically equivalent (CI95 = -0.106, 0.044). Diarrhea, nausea, headache, and dizziness were the most frequently reported drug-related adverse events in both treatment groups; diarrhea and taste perversion were reported more frequently among CLARI recipients. In summary, the combined end of therapy and follow-up clinical evaluation analyses revealed that CIP and CLARI were equally effective in the management of acute sinusitis, although twice as many relapses were reported among CLARI recipients.
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PMID:Double-blind comparative trial of ciprofloxacin versus clarithromycin in the treatment of acute bacterial sinusitis. Sinusitis Infection Study Group. 1021 83

Our goal was to produce a reliable, responsive instrument to quantify disease burden in children with acute sinusitis for use in clinical trials. In a cross sectional survey of 1611 community pediatric patients, parents rated the burden attributable to 13 sinus symptoms. Using logistic regression, we identified five symptoms that predicted the clinical diagnosis of sinusitis. The S5 is the average symptom score for nasal obstruction, daytime and nighttime coughing, headache and colored nasal discharge (range 0-3). The S5 was high in children with acute sinusitis (mean = 1.54, SD = 0.77, N = 93), and low in well children (mean = 0.42, SD = 0.56, N = 1019). We assessed reliability and responsiveness of S5 in a prospective cohort study of 41 children with sinusitis. Parents completed a questionnaire at the office visit, at 12 h and 3, 7, 10 and 14 days. Intra-subject reliability at 12 h was excellent (ICC = 0.94). The S5 score was responsive in 24 patients followed for 14 days who improved (mean change = 1.52, SD = 0.12, p = 0.0062). The S5 score is standardized, reliable, responsive, easily obtained, and can be used to determine study eligibility and assess treatment effects without a physician's evaluation.
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PMID:The development and validation of an instrument to assess acute sinus disease in children. 1047 53

The efficacy and safety of a fixed-combination homeopathic medication (Sinusitis PMD) consisting of Lobaria pulmonaria, Luffa operculata, and potassium dichromate were investigated in an open-label practice-based study of 119 male and female patients, 12 to 57 years of age, with clinical signs of acute sinusitis not previously treated. At the first visit, after a mean of 4.1 days of treatment, secretolysis had increased significantly and typical sinusitis symptoms, such as headache, pressure pain at nerve exit points, and irritating cough, were reduced. Ninety-nine patients received only the test medication. Twenty patients were able to discontinue concomitant medication at the first visit. Only one patient needed an antibiotic. The average treatment duration was 2 weeks. At the end of treatment, 81.5% of patients described themselves as symptom free or significantly improved. Adverse drug effects were not reported.
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PMID:Efficacy and safety of a fixed-combination homeopathic therapy for sinusitis. 1053 78


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