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

Clinical observations and studies support the role of food in causing migraine and sinus headache. Diagnosis of food allergy is based on a diet log, diet trial, and prospective food challenges as indicated. In most cases, patients with food-provoked headache can obtain relief by avoiding a few selected, commonly eaten foods. Benefits of an avoidance diet include the need for fewer medications.
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PMID:Food allergy and headache. Whom to evaluate and how to treat. 336 22

Long neglected as a clinical entity, sinus headache has become a common complaint of patients with facial pain. Although pain is associated with some sinus disease, many experts feel the magnitude and instances of sinus headache have been exaggerated to the public. Birt stated that "otolaryngologists see scores of patients with vague discomfort in the forehead, between the eyes, and across the nose and cheeks." Patients invariably ascribe their symptoms to sinus disease, and are later surprised to discover that they are not infected. In fact, chronic sinusitis is not particularly common, and many headache patients with autonomic features will probably have muscle tension headaches or migraines. Most authors feel that acute or chronic headache processes are not a result of overt paranasal sinus disease. However, the clinician is obliged to consider the possibility in differential diagnosis. This paper will present the anatomic, neurologic, physiologic, and pathologic aspects of paranasal sinus disease and its conceivable relationship to headache and facial pain.
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PMID:Headache and facial pain-the role of the paranasal sinuses: a literature review. 835 6

Sixteen patients were operated on by functional endoscopic sinus surgery. Their principal complaint was facial pain or headache which was thought to be of sinugenic origin. These patients had no osteomeatal complex obstruction on diagnostic nasal endoscopy and also had unremarkable sinus diseases on computed tomography scan of paranasal sinuses. The operative procedures were very limited functional endoscopic sinus surgery which included middle meatotomies with uncinectomies and partial turbinectomies (frontoinferior). Ten patients (62.5%) had no headache postoperatively, and six patients (37.5%) had a reduction in severity. These patients also had a significant reduction in severity of associated nasal symptoms (yellow or green nasal discharge, nasal blockage, postnasal drainage, asthma, allergies). (p < 0.05) The pathophysiologic mechanism of facial pain or headache in these patients is probably related to reversible mucosal disease. This report focuses on a small group of select patients who had specific complaints and had underlying nasal mucosal disease in the form of allergy or vasomotor rhinitis. This therapy is not recommended for every patient, but only a small, selected group of patients who had classic complaints of sinus headache and had had medical treatment failures even if their nasal endoscopy and computed tomography scans were normal.
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PMID:Functional endoscopic sinus surgery in patients with sinugenic headache. 927 85

After reviewing the historic differentiation between migraine and tension-type headache, the authors note that the similarities between these two types of primary headaches outweigh the differences, and so hypothesize that these headaches share a common pathophysiology. The convergence hypothesis for primary headaches links the clinical features of an evolving headache to current pathophysiological models. The authors suggest that successive symptoms experienced clinically reflect an escalating pathophysiological process, beginning with the premonitory period and progressing into tension-type headache and, if uninterrupted, finally into migraine. The clinical manifestations of other headache types, such as so-called sinus headache or temporomandibular headache, may also be explained by this model. A convergence hypothesis for primary headaches has important implications for earlier recognition, diagnosis, and treatment.
Headache 2002 Mar
PMID:Primary headaches: a convergence hypothesis. 1190 44

Sinus headache is commonly diagnosed, and patients with headache often cite sinus pain and pressure as a cause of their headaches. A high frequency of diagnosis of sinus headache, which specialists consider to be relatively rare, among patients meeting International Headache Society (IHS) diagnostic criteria for migraine raises the possibility that migraine and perhaps other headache types are sometimes mistaken for sinus headache. This article considers clinical, epidemiologic, and pathophysiologic relationships between sinus headache and migraine and discusses the implications for clinical management of headache. Both historic and new data show that nasal symptoms frequently accompany migraine, although these symptoms are not part of the IHS diagnostic criteria for migraine. Parasympathetic activation, as well as the hypothesized mechanism of neurogenic or immunogenic switching (i.e., crossover interactions of neurogenic and immunogenic inflammation), may account for both the frequent occurrence of nasal symptoms in migraine and the possibility that sinus inflammation can sometimes act as a migraine trigger. Considered in aggregate, the data show that the occurrence of nasal symptoms associated with a headache should neither trigger a diagnosis of sinus disease nor exclude a diagnosis of migraine. It should, in fact, prompt diagnostic consideration of both conditions.
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PMID:Sinus headache or migraine? Considerations in making a differential diagnosis. 1201 Dec 68

To decide which patients with headache ought to be evaluated for SAH, physicians should focus on specific elements of the patient history, such as onset, severity, and quality of the headache and associated symptoms. These questions should be asked and the responses documented for every patient with a headache. The physical examination should be compulsive with regard to vital signs, HEENT. and neurologic signs. Then, the physician should form an explicit differential diagnosis and have reasons for diagnosing migraine, tension, or sinus headache and other benign causes. If there is no clear-cut alternative hypothesis, the patient should be evaluated by CT and LP (if the CT is negative, equivocal, or technically inadequate). Physicians should understand the limitations of this diagnostic algorithm. In addition, the CSF should be carefully analyzed, including measuring the opening pressure. In patients whose CT scans and CSF analyses are normal, further testing is rarely indicated.
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PMID:Diagnosis of subarachnoid hemorrhage in the emergency department. 1263 Jul 32

The concept of sinus disease as a common cause of headache is deeply ingrained in the American public, but there is little evidence to support the sinuses as a common cause of disabling headache. On the other hand, a body of evidence supports the concept that migraine can present with facial pain and nasal symptoms such as congestion and rhinorrhea. In clinical studies nearly 90% of participants with self-diagnosed or physician-diagnosed sinus headache met criteria for IHS migraine-type headache and responded to triptan interventions in a manner similar to that witnessed in migraine. Consequently it is likely that most individuals seeking medical attention for sinus headache are, in fact, experiencing migraine. Nasal pathologic conditions, however, can also cause sinus headache. In general. other symptoms in addition to headache are also present, but there is clear symptom overlap among migraine, rhinosinusitis, and other nasal passage/sinus pathologic conditions, and further research is needed.
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PMID:Sinus headache: a clinical conundrum. 1506 62

Sinus headache is not a recognized entity by allergy, otolaryngology, or neurological organizations. Headache is a minor feature in the diagnosis of acute rhinosinusitis and is not validated as a symptom in chronic sinusitis. Sinus headaches are self-diagnosed due to weather triggers, bilateral and frontomaxillary location, and the presence of vasomotor signs and symptoms, all of which can accompany the migraine. Over 90% of self-diagnosed and doctor-diagnosed sinus headaches meet the International Headache Society criteria for migraines, and those migraines misdiagnosed as sinus headaches respond to sumatriptan better than placebo because migraines respond to triptans. Sinus headaches are usually severely disabling migraines, misdiagnosed and mistreated, with 61% of patients receiving antibiotic prescriptions for noninfectious causes, thus failing the patients and, in addition, contributing to a serious public health problem.
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PMID:New thoughts on sinus headache. 1517 92

Sinus headache is a common diagnosis when patients have facial pain and pressure accompanying their headache. However, acute sinus headache is in fact rare, and the headache must accompany acute bacterial rhinosinusitis (ABRS), a diagnosis which is based both on clinical and radiological evidence. In fact, sinus headache is a misnomer. The only headache related to sinus disease, as recognised by the International Headache Society (IHS), is headache attributed to rhinosinusitis (HARS; section 11.5 of IHS criteria). Many patients who are diagnosed with sinus headache and treated with antibiotics have a primary headache, usually migraine. This is an important distinction and the treatment is very different. This review covers the most recent definitions, epidemiology, pathophysiology, diagnostics and treatment of ABRS and the resulting headache as defined by the IHS.
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PMID:Therapeutic options in the management of headache attributed to rhinosinusitis. 1593 98

Sinus headache is a widely accepted clinical diagnosis, although many medical specialists consider it an uncommon cause of recurrent headaches. The inappropriate diagnosis of sinus headache can lead to unnecessary diagnostic studies, surgical interventions, and medical treatments. Both the International Headache Society and the American Academy of Otolaryngology-Head and Neck Surgery have attempted to define conditions that lead to headaches of rhinogenic origin but have done so from different perspectives and in isolation of each other. An interdisciplinary ad hoc committee convened to discuss the role of sinus disease as a cause of headache and to review recent epidemiological studies that suggest sinus headache (headache of rhinogenic origin) and migraine are frequently confused with one another. This committee reviewed available scientific evidence from multiple disciplines and concluded that considerable research and clinical study are required to further understand and delineate the role of nasal pathology and autonomic activation in migraine and headaches of rhinogenic origin. However, this group agreed that greater diagnostic and therapeutic attention needs to be given to patients with sinus headaches.
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PMID:Sinus headache: a neurology, otolaryngology, allergy, and primary care consensus on diagnosis and treatment. 1600 96


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