Causes of headache in patients with a primary diagnosis of sinus headache

European Archives of Oto-Rhino-Laryngology (May 2011)

Foroughipour M, Sharifian SM, Shoeibi A, Ebdali Barabad N, Bakhshaee M; 

Headache is a common occurrence among the general population. Although the pain could be a symptom of acute sinusitis, chronic sinusitis is not considered as a usual cause of headache. In addition, autonomic-related symptoms in the sinonasal region may be associated with vascular pain. Confusion regarding these symptoms could lead to an incorrect diagnosis of sinusitis. A prospective cross-sectional study was conducted at two tertiary referral centers with residency programs in otorhinolaryngology, head and neck surgery and neurology. The study included 58 patients with a diagnosis of "sinus headache" made by a primary care physician. Exclusion criteria were as follows: previous diagnosis of migraine or tension-type headache; evidence of sinus infection during the past 6 months; and the presence of mucopurulent secretions. After comprehensive otorhinolaryngologic and neurologic evaluation, appropriate treatment was started according to the final diagnosis and the patient was assessed monthly for 6 months. The final diagnoses were migraine, tension-type headache and chronic sinusitis with recurrent acute episodes in 68, 27 and 5% of the patients, respectively. Recurrent antibiotic therapy was received by 73% of patients with tension-type headache and 66% with migraine. Sinus endoscopy was performed in 26% of the patients. Therapeutic nasal septoplasty was performed in 16% of the patients with a final diagnosis of migraine, and 13% with tension-type headache. Many patients with self-described or primary care physician labeled "sinus headache" have no sinonasal abnormalities. Instead, most of them meet the IHS criteria for migraine or tension-type headache.

Differences in cervical musculoskeletal impairment between episodic and chronic tension-type headache

Cephalalgia 2010


J-H Sohn, H-C Choi, S-M Lee, and A-Y Jun*
Hallym University College of Medicine, Republic of Korea
* To whom correspondence should be addressed. E-mail: ayjun@hallym.or.kr.


Background: Tension-type headache (TTH) is a headache in which musculoskeletal impairments of the craniocervical region may play an important role in its pathogenesis. We investigated the presence of myofascial, postural and mechanical abnormalities in patients with frequent episodic and chronic tension-type headache (ETTH and CTTH, respectively).
Methods: The study population consisted of 36 patients with ETTH, 23 with CTTH and 42 control subjects. Myofascial trigger points (MTrPs) were identified in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles. Sagittal C7-tragus angle was measured to evaluate flexor head posture (FHP), and neck mobility was assessed using an inclinometer.
Results: Only active MTrPs were significantly different between the ETTH and CTTH groups (p < .001). Patients with CTTH showed a larger sagittal C7-tragus angle (p = .011), that is, greater FHP and restricted neck mobility for both rotations compared to controls (p < .001). Although active MTrPs were correlated with the frequency and duration of headache, no correlations were observed for FHP or neck mobility. Conclusion: Active MTrPs in the craniocervical region contribute to triggering or maintenance of TTH and posture or neck mobility may be a result of chronic headache.






First published on July 7, 2010

Cephalalgia 2010, doi:10.1177/0333102410375724

Advances in the Pathophysiology of Tension-type Headache: From Stress to Central Sensitization

Current Pain and Headache Reports 2009, 13:484-494 Current Medicine Group  LLC ISSN 1531-3433 Copyright © 2010 by Current Medicine Group LLC

Yaniv Chen, MDCM

Corresponding author:
Yaniv Chen, MDCM
Department of Neurology, NYU Medical Center, New York University, 550 First Avenue, New York, NY, 10016.
Email: yaniv.chen@nyumc.org

Tension-type headache (TTH) is the most common and most socioeconomically costly headache.
Yet our knowledge regarding TTH pathophysiological mechanisms is still in its early stages. Psychological stress and weak coping mechanisms may initiate and propagate physiological pain via activation of second messengers in downstream substrates involved in pain.

It seems that peripheral mechanisms are predominant in the episodic type (ETTH), whereas central mechanisms are involved in the chronic type (CTTH) of tension headache.

The conversion from ETTH to CTTH is most relevant to the clinician and the patient, as CTTH is the most debilitating.

This paper focuses and summarizes our current understanding of central sensitization, the process by which this conversion occurs in TTH, and proposes an integrated model to explain how ETTH progresses into CTTH in genetically susceptible individuals.