Diagnosis and Management of Headaches: The Otolaryngologist’s Role

As many types of headache tend to masquerade as sinus headache, an understanding of the peripheral mechanisms of specific headache types is essential for otolaryngologists to effectively diagnose and treat patients, according to a study published in the American Journal of Otolaryngology.  

In this literature review on the diagnosis and management of migraine, trigeminal neuralgia, and rhinogenic headache, researchers sought to derive a clinical decision-making algorithm regarding patients presenting with the symptoms of sinus headache. Relevant articles included were published in the previous 10 years and were found through Cochrane Library, Google Scholar, and OVID MEDLINE.

The review authors found that the specific cause must be determined before rhinogenic headaches can be treated. They found discussions of a variety of potential therapies, but not their effect on headache amelioration. Patients with contact point headaches may experience improved quality of life after the removal of their mucosal contact points. New balloon dilation techniques for the treatment of sinusitis remain controversial.

With regards to trigeminal neuralgia, although the gold standard is microvascular decompression, pain control can be achieved via percutaneous therapies.

Migraine patients who report relief after targeted injections of botulinum toxin may benefit from nerve avulsion or definitive decompression. Migraine surgery will have poorer outcomes for patients with mucosal contact points that are not addressed simultaneously.

The review authors conclude that a comprehensive knowledge of diagnostic criteria and therapeutic options for the most common types of headache, particularly migraine, is essential for the proper management of patients presenting with rhinogenic headache symptoms. “Migraine can have considerable overlap in symptomatology with rhinologic disease such as sinusitis and allergic rhinitis, both presenting with frontal headache, nasal congestion and lacrimation, and can exist simultaneously in the same patient, necessitating recognition of both.”

Reference

Hu S, Helman S, Filip P, Cabin J, Colley P. The role of the otolaryngologist in the evaluation and management of headaches. Am J Otolaryngol. 2019;40(1);115-120.