Rhinopathic Headaches

Abstract

Headache is universal in the human experience. Despite the familiarity most of us have with the symptom, the cause of most headaches remains a mystery. Much of modern research has focused on headache mechanisms (such as spreading cerebral electrical depression, serotonin receptor properties, and vasodilatory mechanisms) rather than headache causation. Pain referred from the sinonasal tract is one preventable cause of headache. The anatomical basis for the relationship between headache and the sinonasal tract is the trigeminal nerve (CN V). The fifth cranial nerve not only provides sensory fibers to the nasal cavity and paranasal sinuses, but innervates pain-sensitive structures in the cranial cavity, such as dura and intracranial blood vessels, thus providing the basis for referred headache. The headache and facial pain that accompany acute sinusitis are fairly well recognized, chiefly owing to the obvious nasal symptoms, such as purulent rhinorrhea, nasal congestion and obstruction, post-nasal drip, and cough. The concept of headache referred from the sinonasal cavity without overt nasal symptoms or gross mucosal disease is rapidly gaining acceptance, largely owing to the enhanced diagnostic capabilities afforded by rigid nasal endoscopy and coronal computed tomography (CT). This chapter will focus on headache as a symptom of various sinonasal pathophysiologic processes, which may or may not be accompanied by nasal symptoms or inflammatory sinus disease. The term “primary headache” will be used in this chapter to denote the vascular- or tension-type headaches (migraine, cluster, chronic daily headache, tension headache, and so on) traditionally thought to be unrelated to any underlying organic pathology.