OBJECTIVE: The aim of this manuscript is to analyse a diagnostic protocol to select correctly patients with Rhinogenic Headache Contact Point (RH) and to investigate the effect of surgical treatment and medical therapy in pain relief.
METHODS: A prospective no-randomized study selected adult patients with headache and nasal alteration at CT exam or endoscopic vision with positive response to test with nasal spray with corticosteroids and antihistamine or/and local anesthesia test to the contact points. MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month were collected in patients who performed surgery and in patients who performed medical therapy.
RESULTS: Following the inclusion, 415 patients were selected for this study. 302 patients performed nasal surgery (septoplasty, turbinoplasty and/or endoscopic surgery with centripetal technique), 113 performed medical therapy. There was a statistically significant improvement in MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month in patients who performed surgery and in patients who performed medical therapy. Regarding the comparison between patients who performed surgery (Group A) and patients who performed only medical therapy for RH (Group B), better outcomes were obtained by Group A. Considering the daily life handicap index, the lowest handicap was obtained in Group A.
CONCLUSIONS: This study demonstrates that surgery, using in some cases centripetal technique, gives an improvement statistically significant than medical therapy in RH. The use of nasal spray with corticosteroids and with anti-histamine is a good method in the diagnosis of RH, especially in patients with anatomical variants such as concha bullosa, agger nasi cells and Haller cells.

UNASSIGNED: The objectives of this study were to analyze rhinogenic headache, i.e., noninflammatory frontal sinus headache, a headache caused by bony obstruction of the frontal sinus drainage channels that receives relatively insufficient attention clinically, and to propose endoscopic frontal sinus opening surgery as a treatment based on the etiology.
UNASSIGNED: Case series.
UNASSIGNED: From the data of patients with noninflammatory frontal sinus headache who underwent endoscopic frontal sinus surgery in Hospital of Chengdu University of Traditional Chinese Medicine during 2016-2021, data for three cases with detailed postoperative follow-up data were extracted for case series reports.
UNASSIGNED: This report provides detailed information on three patients with noninflammatory frontal sinusitis headache. Treatment options include surgery and rechecking, with the visual analogue scale (VAS) scores of preoperative and postoperative symptoms, CT, and endoscopic images. Three patients had common characteristics: the clinical manifestations were recurrent or persistent with pain and discomfort in the forehead area, but there was no nasal obstruction or runny nose; the paranasal sinus CT revealed no signs of inflammation in the sinuses but suggested bony obstruction of the drainage channel of the frontal sinus.
UNASSIGNED: All three patients had recovery from headache, nasal mucosal recovery, and patent frontal sinus drainage. The recurrence rate of forehead tightness and discomfort or pain was 0.
UNASSIGNED: Noninflammatory frontal sinus headache does exist. Endoscopic frontal sinus opening surgery is a feasible treatment modality that can largely or even completely eliminate the stuffy swelling and pain in the forehead. The diagnosis and surgical indications for this disease are based on a combination of anatomical abnormalities and clinical symptoms.

To assess the clinical outcome of endoscopic septoturbinal surgeries in patients with rhinogenic contact point headache. Retrospective audit of medical records. Retrospective audit of medical records of patients having undergone endoscopic surgical management for contact point headache between a period of May 2017 to May 2018 were included in the study. Patients who underwent functional endoscopic sinus surgery were excluded from the study. Pre operative pain score were compared with post operative pain score at interval of 1 month for 3 months consequently and at 1 year interval using Visual Analog scale (VAS). The difference between preoperative (mean 6.82) and post operative VAS pain scores after 1 month (mean 3.36), 2 months (mean 4.50), 3 months (mean 5.48), 1 year (mean 5.01) was statistically significant (p < 0.001). Contact point headache is an important clinical entity that might be missed during evaluation and management of refractory headache. Surgical management under endoscopic guidance can help to ensure removal of mucosal contact point and aid in the treatment of refractory headache as noted in our study.

Pediatric headache is a common medical complaint managed across multiple subspecialties with a myriad of unique factors (clinical presentation and disease phenotype) that make accurate diagnosis particularly elusive. A thorough understanding of the stepwise approach to headache disorders in children is essential to ensure appropriate evaluation, timely diagnosis, and efficacious treatment. This work aims to review key components of a comprehensive headache assessment as well as discuss primary and secondary headache disorders observed in children, with a particular focus on clinical pearls and \"red flag\" symptoms necessitating ancillary diagnostic testing.

Headache is a common clinical problem, and appropriate diagnosis and management are a challenge for oral physician. Any minor anatomical variation within the nasal cavity may lead to mucosal contact point, which may be an etiological factor for causing headache and often left behind by clinician during preliminary evaluation of patients with headache or facial pain, resulting in misdiagnosis and inappropriate treatment. This article is an attempt to present a case of rhinogenic contact point headache which may be mistaken for a toothache initially leading to incorrect diagnosis and irrelevant treatment. A thorough, accurate and comprehensive history taking and a complete clinical and general physical examination result in appropriate diagnosis of the clinical situation.

暂无摘要。

Aggiornamento sulla fisiopatologia e sul trattamento della cefalea rinogena: focus sull’utilizzo combinato di ibuprofene e pseudoefedrina.
UNASSIGNED: La cefalea rinogena è frequente nella pratica clinica. Il trattamento di questa patologia dovrebbe essere basato su un’appropriata valutazione della sottostante fisiopatologia. La combinazione di due o più farmaci, ed in particolare ibuprofene e pseudoefedrina, a dosaggi fissi si è dimostrata più efficace delle monoterapie. Al momento la combinazione ibuprofene/pseudoefedrina a dosaggio fisso è commercializzata quale farmaco da banco. Questo lavoro si focalizza sulla revisione in dettaglio della fisiopatologia della cefalea rinogenica e discute il razionale del trattamento mediante la combinazione ibuprofene/pseudoefedrina.
Rhinogenic headache is frequently encountered in clinical practice. Treatment of this condition should be based on a proper evaluation of its underlying pathophysiology. Fixed-dose combinations of two or more active agents, and specifically the combination of ibuprofen plus pseudoephedrine, have been shown to be more efficacious than either monotherapy. At present, an ibuprofen/pseudoephedrine fixed-dose combination is available as an over-the-counter drug. This paper reviews in detail the pathophysiology of rhinogenic headache and discusses the rationale for treatment of this condition with a fixed-dose ibuprofen/pseudoephedrine combination.

BACKGROUND: Rhinogenic headache is a painful sensation in the head and face due to intranasal contact point without any mass or inflammatory findings. Surgery is recommended in patients with nasal obstruction; however the approach in case of isolated mucosal contact point that does not cause obstruction is controversial. Our aim is to observe changes in the severity of headache in patients with isolated mucosal contact point and headache who do not complain of nasal obstruction.
METHODS: Our study included patients with unilateral headache without any nasal and/or paranasal sinus pathology. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography (CT). One hundred patients with isolated mucosal contact point without any problem in breathing were included in this study. All participants were treated by topical nasal corticosteroid for a month. Surgery was recommended to the patients with no satisfactory relieve of headache. Visual Analog Scales (VAS) were used to evaluate the severity of headache in patients at time of diagnosis (0 month), after a medical treatment (1st month) and after a surgical or medical treatment (6th month). The results were compared with each other statistically.
RESULTS: There was a decrease in VAS values after a month of medical treatment in all patients with isolated contact point (Z = -8.352; p = 0.0). VAS values significantly improved after surgical treatment group (Z = -4.97; p = 0.0). However, VAS values of patients increased at 6th month in medical treatment group (Z = -5341 p = 0.0). After a successful surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with surgical treatment group than in the patients with medical treatment group (Z = -8.441; p = 0.0).
CONCLUSIONS: Surgical correction provides a more effective outcome in patients with rhinogenic headache. However, it is difficult to convince that headache may improve with surgery in these patients especially with isolated mucosal contact point and without nasal obstruction. In order to prove the benefit of surgery, we believe that medical treatment can be used as a guide.

Although some causes of rhinogenic headache, such as acute sinusitis, have clear diagnostic criteria, others, such as \"sinus headache\" and mucosal contact points, are more nebulous. Misdiagnosis of these entities and primary headaches may result in unnecessary medical or surgical treatment. The purpose of this systematic review is to delineate current understanding of diagnosis and treatment of rhinogenic headaches, including sinus and mucosal contact point headaches, in children.
PubMed, SCOPUS, and the Cochrane databases were searched for studies on sinus headache and mucosal contact point headaches in children. Studies were assessed for level of evidence, and risk of bias was assessed by Methodological Index for Non-Randomized Studies (MINORS) scoring. Diagnostic criteria, management strategies, and other clinical data were analyzed.
Eight studies met the inclusion criteria. Level of evidence was predominantly 4. Forty percent of pediatric patients with migraine had been previously misdiagnosed with sinus headache. Of 327 pediatric patients in two studies, between 55% and 73% had at least 1 cranial autonomic symptom associated with their migraine. For children with mucosal contact point headaches, surgical management in select patients improved headache intensity or severity in 17 (89%) cases.
The majority of pediatric patients with sinus headache harbor a primary headache disorder, with migraine being most common. Physicians should suspect primary headache disorders in pediatric patients with chronic headaches and a normal exam. Although some case series are supportive of surgical management for mucosal contact point headaches in children, the level of evidence supporting these recommendations is insufficient. High-quality clinical trials are necessary for continuing to improve outcomes in patients with these clinical entities.

Headache is not infrequently one of the major complaints in the patients visiting the otorhinolaryngologist\'s office. It was estimated to occur in 24% of the patients presenting with chronic sinusitis. The cause of headache may be pathological processes either in the nasal cavity or in the paranasal sinuses as well as a primary disorder in the nervous system. The present article is concerned with the peculiar features of rhinogenic headache and that of a different etiology. It was shown that the patients suffering from headache are in need not only of the obligatory otorhinolaryngological examination including endoscopy of the nasal cavity, X-ray study and, sometimes, specialized tests but also of neurological counseling. However, the surgical treatment does not always results in the elimination or relief of the rhinogenic headache. Hence, the importance of the evaluation of the risks and benefits of such treatment for an individual patient. The formation of the contact points in the nasal mucosa is considered to be one of the possible causes of rhinogenic headache. However, this opinion needs to be confirmed by the results of large-scale comparative clinical studies.
Головная боль нередко является основной жалобой у пациентов на приеме у врача-оториноларинголога. Она беспокоит 24% пациентов с хроническим синуситом. Причина головной боли может быть связана как с патологией носа и околоносовых пазух, так и с первичными нарушениями нервной системы. В статье уточнены особенности риногенной и нериногенной головной боли. Показано, что пациент с головной болью в обязательном порядке должен пройти не только отоларингологическое обследование, включающее эндоскопию полости носа, рентгенологические методы и в некоторых случаях специальные пробы, но и получить консультацию невролога. Даже в случае установления риногенного характера головной боли хирургическое лечение хронического синусита не всегда приводит к исчезновению или уменьшению головной боли, поэтому перед операцией особое внимание нужно уделять соотношению пользы и риска для пациента. Одной из возможных причин головной боли считается наличие контактных точек слизистой оболочки полости носа, однако данная концепция нуждается в подтверждении в крупных сравнительных клинических исследованиях.