Sinonasal pathology and headaches

Primary headaches or other chronic headaches can be triggered by sinonasal pathologies, or variations within the sinonasal tract. Establishing a cause and effect relationship between certain sinonasal conditions and chronic headaches can justify sinonasal surgery for the relief of headaches and provide considerable relief to a subgroup of patients with chronic headaches resistant to medical treatment. A prospective study on 204 patients undergoing sinonasal surgery for an apperent symptomatic sinonasal pathology was conducted to determine the incidence and types of headaches in sinonasal patients preoperatively, the presence of potential sinonasal triggering mechanisms, and postoperative headache relief when such triggers are removed. The relationship between potential triggers and postoperative relief is analysed to determine a possible link. Headache was a major complaint in 50% of these patients and the overall incidence of primary type headaches was 25.5% (52 of 204 patients). Postoperatively, 83.4% of the patients expressed improvement of the headaches (85/102). High scores of preoperative Sinonasal Headache Quotient (SNHQ), obtained through a general questionnaire and endoscopic/radiologic work up seems to correlate well with postoperative relief of headaches (p < 0.0001), as well as a well defined lesion site and an ipsilateral pain localization (p < 0.02). A detailed sinonasal analysis of chronic headache patients may help identify a subgroup with potential sinonasal triggers and these patients may experience considerable relief of headache following surgery.