Headaches are the most common health problem yet they can be complicated than most people realize. Each headache has its own set of symptoms which can happen for unique reasons and also needs to be treated differently. There are over 150 types of headaches. But let’s focus on rhinogenic headaches. It is a major health issue that is frequently encountered in clinical practice. Diagnosing a rhinogenic explanation for headache or facial pain outside of the classic definitions of chronic, acute, and subacute sinusitis is often challenging for the practicing otolaryngologist. Contact-point headaches are clinically characterized as causing facial pain secondary to abutting mucosal contact from the lateral nasal wall to the septum. Otolaryngologists see an outsized number of patients with rhinogenic headaches. The majority of patients with this condition are males aged 10-30 years.

So, what is Rhinogenic Headache?

Rhinogenic headache may be a pain within the head and face due to the intranasal contact point. These headaches have their primary pathophysiology centered in the nose with a headache or facial pain as a result of complex neurohumoral reflexes. Acute rhinosinusitis is that associated with the most common rhinogenic headache. Most cases are caused by viral infections (up to 98%), and only 2% are complicated by bacterial sinusitis. However primary care physicians often treat sinusitis as an acute bacterial infection by prescribing antibiotic therapy and hence contributing to the onset of resistance. Rhinogenic headache is often misdiagnosed as other conditions such as migraine.

Rhinogenic pain is usually unilateral, severe, located on an equivalent side and associated with rhinogenic symptoms, and nearly always amid endoscopic and CT abnormalities. Incidental CT mucosal diseases are often noted in 30% of asymptomatic patients.

The symptoms to look out for to know if you have Rhinogenic headache.

The symptoms of Rhinogenic headache can look like any other health-related issue. Symptoms may be different for each person. They might include:

• Facial pain or pressure that gets worse while leaning forward
• Nasal congestion
• Postnasal drip
• Toothache in the upper jaw
• Fever
• Cough
• Yellowish or greenish discharge from the nose
• Pain in the upper jaw
• Headache
• Deceased smell
• Ear pressure or fullness

If you notice any combination of the above symptoms visit your ENT doctor for appropriate treatment.

Diagnosis and treatment

Rhinogenic headache can often be misdiagnosed which can then lead to improper treatment thus a detailed diagnosis is needed to identify. Once the practitioner has examined you thoroughly the treatment for the same would begin. It can be treated medically as well as surgically, both treatments have significant reduction although surgical treatment has better results.

A thorough history which incorporates elicitation of nasal congestion, symptom, facial pain, pressure, dental pain, anosmia, fever, cough, fatigue, ear fullness or pressure, precipitating factors causing the headache (head movement, stress, or cold weather after which a complete nasal endoscopy and CT scan of nose and sinuses are mandatory to make a diagnosis. Whether or not any consultation to a neurologist, allergist, or TMJ specialist has been performed, and whether or not therapy by these specialists has failed to overcome their headache. Following the history, a thorough ENT is examination is necessary with palpation of the sinuses to elicit tenderness.

Once the diagnosis has been made an aggressive medical therapy is indicated. A referral to a neurologist or TMJ specialist is encouraged as well. This is when there is no evidence or history of sinus disease on an exam or CT scan and especially there are no anatomical abnormalities. The medical therapy includes steam, hot and cold compresses, antibiotics if the sinuses have been noted, saline irrigation, analgesics, treatment of the allergy problem with steroid nasal spray, antihistamines, and leukotriene inhibitors, and time.

If the medical therapy fails then a lengthy discussion must ensue before any surgical intervention. An evaluation by a neurologist and TMJ specialist must be included for a failed medical therapy. Before the surgery full discussion of risks, benefits and alternatives is needed.

Surgery can then be performed to correct any or all of the anatomical variants that are felt to be the cause of the headache. If there is indeed a septal spur, then septoplasty should be performed in whatever manner one prefers, be it endoscopic removal of the spur, submucosal resection, or the traditional Cottle approach. Concerning endoscopic sinus surgery, this too is extremely controversial, in particular, if on a CAT scan there is no evidence of sinus disease. A repeat CT is sometimes necessary since one CT is only a snapshot in time. If indeed there is evidence of sinus disease on CT, then the indications are more definite and one needs to address the sinuses that are involved. If there is no evidence of sinus disease, then one should not operate on the sinuses unless there has been evidence of rhinosinusitis on history and exam.

So if you are experiencing the symptoms don’t ignore them and visit the doctor. The sooner you treat it the better. With proper diagnosis and treatment, it will be gone for good.

Headaches are one of the most prevalent health conditions faced by humans. There are many different types of headaches, with sinus headaches and migraines being the most common ones. The two are often misdiagnosed as both migraine and sinus headaches have similar symptoms such as runny nose and tenderness in the cheeks and forehead. This makes it hard to differentiate between the two. To understand the differences between the two, let us get an overview of sinus headaches and migraines, along with their characteristics.

Sinus Headache

Sinus headaches are characterized by the deep and constant pain in your sinuses and surrounding areas – eyes, cheeks, nose, and forehead. The pain comes with a throbbing sensation, and this is caused when there is an inflammation in the sinuses and the nasal passages. Other indicators, such as runny nose, fever, ear block, and a swollen face, also accompany the sinus headaches. Sinus headache is usually a symptom of sinusitis (sinus infection).

In sinusitis, the sinuses become inflamed, blocking the nasal passages. Healthy sinuses are filled with air, and the fluid buildup within the sinuses causes swelling in the nasal cavity. This can be caused due to viral/bacterial infections or seasonal allergies that last for an extended period.

Symptoms of Sinus Headache

• Pain/pressure in the forehead and cheeks
• Increasing pain on bending forward or lying down
• Runny/stuffy nose
• Tiredness
• Fever

Risk Factors of Sinus Headache

• Seasonal allergies
• Common cold
• Ear infection
• Nasal polyps
• Deviated Nasal Septum
• Weak immune system
• Previous history of sinus headaches
• Family history of migraines/sinus headaches

Migraine

Migraine causes severe, throbbing pain on one side of the head. The pain is more like a pulsing sensation in the head, often accompanied by nausea, photosensitivity, and sensitivity to sound. A migraine attack can last from a few hours to several days, depending on the severity of it, and it may also interfere with one’s daily activities.

A warning symptom, commonly known as an aura occurs before or during the headache. This can include flashes of light, blind spots, a tingling sensation on one side of the face or limb, and speech difficulty.

Symptoms of Migraine

There are four stages of a migraine attack – prodrome, aura, attack, and post-drome. However, not everyone goes to all four stages. The most common symptoms during each stage are:

• Prodrome
• Constipation
• Mood swings
• Food cravings
• Stiffness in the neck
• Frequent yawning
• Aura
• Blind spots
• Loss of vision
• Stinging sensation in the limbs
• The feeling of numbness on one side of the body
• Speech difficulty
• Attack
• Immense pain on one side of the head
• Throbbing ache
• Photosensitivity
• Sensitivity to sound
• Nausea
• Post-drome
• Fatigue
• Lightheadedness
• Sudden pain while moving the head

Migraine Risk Factors

• Family history of migraines
• Age (Migraine often occurs first during adolescence and peaks during the 30s)
• Hormonal changes
• Skipping meals
• Smoking
• Depression or anxiety
• Alcohol abuse

How can you differentiate between a Sinus Headache and a Migraine?

According to research, many people diagnosed with sinus headaches are usually experiencing a migraine attack. While telling the two conditions apart, the most important factors to consider are the symptoms and the timing, based on which the right treatment is given.

While some of the common symptoms of both sinus headaches and migraines include a running nose, watery eyes, and tenderness/pressure on the forehead, various other symptoms set them apart.

In case of a sinus headache, the mucus discharge will be yellowish, while the drainage will be clear in case of a migraine. Sinus headaches are often accompanied by fever and bad breath, while a migraine may cause nausea, dizziness, fatigue, and sensitivity to light. Women are much more prone to migraine attacks as compared to men.

Apart from the symptoms, it is important to note the timing of the headache. If the headache occurs after infections such as the common cold or flu, or after allergic reactions, it is most likely to be a sinus headache. However, if the headache occurs after consuming certain foods/alcohol, highly stressful situations, skipping a meal, insomnia, or other lifestyle-related factors, it is a migraine attack.

To diagnose a sinus headache or migraine, your doctor will ask you specific questions related to your headaches such as the frequency at which they occur, the symptoms you experience, the timing/triggers, and the family history. The doctor may also suggest physical examination, blood tests, or imaging tests for accurate diagnosis.

Treatment for sinus headache/sinusitis includes self-care measures such as steam inhalation, usage of nasal wash, nasal irrigation, and over-the-counter (OTC) medications. If the condition is severe, the doctor might prescribe corticosteroids, antibiotics, or surgery.

The treatment for migraine attacks is divided into two – acute treatment and preventive treatment. The acute treatment aims at easing the symptoms to provide relief such as moving to a cool and darkroom, cold compress, fluid consumption, OTC pain relievers, and anti-nausea medications. Preventive treatment includes various lifestyle changes such as a regular exercise regime, stress management, regular sleep schedule, avoiding exposure to triggers, and more.

Be it sinus headache or migraine attacks, the most important step towards nipping it in the bud is to be aware of the symptoms and approach your healthcare provider for the right diagnosis. Though treatment methods are available to relieve the symptoms, one can be mindful of the risk factors and avoid exposure to triggers, for prevention is better than cure!

Chronic sinusitis is an illness that causes inflammation of the lining of the nose and the sinuses. Symptoms of chronic sinusitis include facial pressure, nasal congestion, discolored nasal discharge, and post-nasal drip. The majority of the patients with chronic sinusitis can be treated with medication. However, for a small percentage of patients, infections recur and may persist for a longer course even after medication. Such patients benefit from surgery. After reviewing your medical history and x-ray studies, your ENT specialist can determine if surgery is needed.

What is balloon Sinuplasty?

Balloon sinuplasty is also known as balloon catheter dilation surgery or “smart sinus” procedure. It is a relatively new surgery and is a procedure to clear blocked sinuses. It has been approved by the Food and Drug Administration in 2005.

Balloon Sinuplasty was adapted from angioplasty, a procedure in which balloon catheters are used to dilate congested blood vessels near the heart.

The complications of the procedure are reportedly minimal and the recovery period is quite short. While the procedure is minimally invasive, it is still a surgery and it carries the kind of risks of a few side effects.

How does Balloon Sinuplasty work?

Most people who need the surgery have a condition that results in the sinus membranes becoming inflamed, preventing drainage of mucus, pus, and discharge, and causing congestion. Over time, blockage and inflammation in the nasal passages can cause symptoms, such as a headache, jaw ache, and even insomnia.

Balloon sinuplasty allows the openings of some or all three of the major nasal sinuses to be dilated. The doctors widen the blocked nasal passages by flushing out or remove congestion, often by using a saline solution.

This helps them to be cleared and drained. Balloon sinuplasty uses small balloon catheters that inflate to drain the large nasal sinuses and is typically used to treat cases of severe rhinosinusitis or sinus inflammation and blockage in the nose.

What does the balloon sinuplasty procedure include?

Depending on individual factors and preferences, balloon sinuplasty is done by an ear, nose, and throat (ENT) doctor in their office, clinic, or a hospital.

After administering a local or general anesthesia, a doctor inserts an endoscope, a thin, flexible plastic tube with a camera and light on the end, into the nasal passages. On reaching the entrance to the cavity, a small balloon catheter is advanced over the guiding endoscope wire.

The balloon is then slowly inflated and pressed against the sinus walls, once it is positioned inside the nasal passage and cavity. This is done to fracture the bone slightly and force an opening. Once the balloon is fully inflated, the cavities and passageways are flushed out using a saline rinse, and debris is further removed. Once the balloon is removed the sinus is allowed to continue to drain naturally.

Most people who undergo balloon sinuplasty have reported feelings of numbness or sinus pressure only during the surgery. Any noticeable pain is not reported.

Advantages of Balloon Sinuplasty over traditional methods

Endoscopic sinus surgery is a procedure to open the natural drainage pathways of the sinuses to restore their independent function. Endoscopic surgery comes with its risks and complications such as bleeding, recurrence of disease, spinal fluid leak, visual issues, etc.

Benefits of balloon sinuplasty over traditional endoscopic sinus surgery

• There is a lower risk of bleeding
• Faster recovery
• Since there isn’t any removal of sinus tissues, structures, bones, or sinus cartilage, there is no intended damage
• Fewer required post-operative sessions
• Fewer medications required during and post-operation
• reduced risk of scarring and continued inflammation

What happens after the surgery?

Usually, sinuplasty tends to have minimal side effects. However, most people can go home a few hours after the surgery is complete and return to normal activities in a day or two.

Some common side effects of Balloon Sinuplasty

• Bloody drainage for a few days
• Nasal, cheek, or forehead tenderness
• Minor swelling in the nasal cavities and passages
• Minor swelling in the surrounding facial area
• congestion
• Failure to properly cleanse the sinuses after the surgery can sometimes cause infection

Regardless of these minor side effects, Balloon sinuplasty is considered a very safe and effective procedure. After it was first introduced in the mid-2000s, balloon sinuplasty has become one of the most commonly performed types of sinus surgeries. It gains its popularity by being associated with high rates of success and low risks or complications.

A study conducted in 2016 found that all 15 adults who received balloon sinuplasty reported improved symptoms 3-6 months post-surgery, without any unanticipated complications or side effects. Similarly, a study done in 2017 found that balloon sinuplasty was successful in treating 94 percent of chronic sinusitis in 30 children who underwent the surgery. The positive effects persisted even a year post-surgery.