虽然鼻源性头痛的一些原因,比如急性鼻窦炎,有明确的诊断标准,其他人,如“窦性头痛”和粘膜接触点,更加模糊。这些实体和原发性头痛的误诊可能导致不必要的药物或手术治疗。本系统综述的目的是描述当前对鼻源性头痛的诊断和治疗的理解。包括鼻窦和粘膜接触点头痛,在儿童。
PubMed,Scopus,并在Cochrane数据库中搜索有关儿童窦性头痛和粘膜接触点头痛的研究。评估研究的证据水平,偏倚风险通过非随机研究方法学指数(MINORS)评分进行评估.诊断标准,管理策略,并对其他临床资料进行分析。
8项研究符合纳入标准。证据水平主要为4。40%的小儿偏头痛患者以前曾被误诊为窦性头痛。在两项研究中的327名儿科患者中,55%至73%的患者有至少1例与偏头痛相关的颅骨自主神经症状.对于粘膜接触点头痛的儿童,部分患者的手术治疗改善了17例(89%)患者的头痛强度或严重程度.
大多数患有窦性头痛的儿科患者患有原发性头痛,偏头痛是最常见的。医师应怀疑患有慢性头痛和正常检查的儿科患者的原发性头痛疾病。尽管一些病例系列支持儿童粘膜接触点头痛的手术治疗,支持这些建议的证据水平不足.高质量的临床试验对于继续改善这些临床实体患者的预后是必要的。
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.