Nonsinogenic facial pain and the role of the sino-nasal outcome test.

Abstract

Facial pain & otorhinolaryngologist Facial pain can be a debilitating symptom and has an estimated incidence in the general population of 38.7 per 100,000 per annum [1]. As such, chronic facial pain is among the commonest of complaints presenting to the otorhinolaryngologist, particularly to those providing a comprehensive rhinology service: facial pain was reported by 25% of 7705 patients presenting to an otorhinolaryngology clinic with rhinological complaints [2], and in a large series of 973 consecutive patients attending a tertiary referral rhinology clinic, 42% presented with facial pain and/or pressure [3]. Recent publications, most notably the 2012 European Position Paper on rhinosinusitis [4] and the revised 2013 International Headache Society classifiation of headache disorders [5], have better defined sinogenic and nonsinogenic facial pain, and have placed this symptom in the context of rhinosinusitis. Nonetheless, it remains a common assumption among the lay public and nonspecialist healthcare professionals alike that all facial pain is the consequence of underlying sinus disease, with patients invariably describing their facial pain as ‘sinus headaches’ [2,6]. This notion, however, contradicts published evidence, with the majority of chronic facial pain being attributable to a number of nonsinogenic conditions, most commonly facial migraine and midfacial segment pain (MFSP) – a myofascial pain syndrome with the characteristics of tension-type headache with the exception that it affects the midface [2,7]. A recent study of 100 consecutive patients with self-diagnosed ‘sinus headache’ revealed only 3% to be the result of chronic rhinosinusitis (CRS) [8], while as few as 11% of patients with CRS report symptoms of facial pain [4].