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Published on: June 2, 2014
Clinical Features and ICHD Headache Diagnoses for Patients With Prominent Craniofacial Pain Referred by a Rhinologist
Ashhar Ali, Odei Alayyas1, Jyotika Singh2
1Department of Neurology, Henry Ford Hospital, Detroit, MI.
Objectives:
Most patients diagnosed with "sinus headache" are misdiagnosed and mistreated. These patients are often referred to otolaryngology for sinus disease evaluation. However, collaborations between rhinologists and headache specialists for "sinus headaches" have not been investigated. This study aimed to report the clinical features and headache diagnoses of patients referred to headache specialists for prominent craniofacial pain.
Methods:
We conducted a retrospective study of patients presenting with craniofacial pain to rhinologists and subsequently referred to a headache specialist for presumed, nonsinogenic, craniofacial pain. Records from a total of 98 patients were reviewed, and information regarding demographics, gender, nasal endoscopy findings, SNOT-22 (Sino-Nasal Outcome Test-22 questionnaire) score, ICHD (International Classification of Headache Disorders) headache diagnosis, and headache characteristics were extracted.
Results:
Nasal endoscopies performed by the rhinologists were normal in 92.7% of patients, edema was noted in 5.2% of patients, and mucopurulence in 2% of patients. The majority of patients described their pain as frontal or frontal-maxillary, dull or throbbing, and moderate to severe. Migraine was the most common final diagnosis in 49.1% of patients and the second most common diagnosis was tension-type headache in 17.3%. The remaining patients were diagnosed with 11 additional ICHD diagnoses.
Conclusions:
Patients referred from a rhinologist to a headache specialist for nonsinogenic craniofacial pain are frequently diagnosed with primary headache disorder, specifically migraine or tension-type headache. Collaboration between specialists may improve diagnostic accuracy and outcomes, although further studies are crucial.
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