Department of ENT, Queens Medical Centre, Derby Road, Nottingham, UK.
Clin Otolaryngol. 2012 Jun;37(3):207-12. doi: 10.1111/j.1749-4486.2012.02478.x.
There is a common misconception that facial pain and headache are mainly caused by sinusitis. The findings of nasal endoscopy, computer tomography (CT) and the results of observational studies reveal that this is not the case. Moreover, when sinus surgery is performed in patients where headache/facial pain has been a feature, it has been found that these symptoms persist after sinus surgery, particularly where there had been no nasal symptoms or endoscopic signs of paranasal sinusitis.
This review was based on a literature search performed on 30 November 2011. The MEDLINE, EMBASE and Cochrane databases were searched using the subject heading of facial pain, that is, rhinosinusitis, migraine, cluster headaches, midsegment facial pain, trigeminal neuralgia, paroxysmal hemicrania, hemicrania continua and drug-dependent headache. The search was limited to English language articles. Relevant references from selected articles were reviewed after reading the abstract.
A review of the literature shows that headaches are rarely caused by sinusitis. Similarly, only a small proportion of patients with facial pain have sinusitis, and these patients have either acute sinusitis or an acute exacerbation of chronic purulent sinusitis. Importantly, most patients with chronic rhinosinusitis rarely have facial pain unless they develop an acute infection or suffer barotrauma. CT scans should not routinely be performed for facial pain because of the prevalence of incidental changes in asymptomatic patients. Surgery is very rarely indicated in the treatment for chronic facial pain.
A structured history of the pain and its associated symptoms, nasendoscopy and relevant targeted investigations should lead to a correct diagnosis and the appropriate treatment.
人们普遍存在一种误解，认为面部疼痛和头痛主要是由鼻窦炎引起的。鼻内窥镜、计算机断层扫描（CT）的检查结果以及观察性研究的结果表明，事实并非如此。此外，当对以头痛/面部疼痛为特征的患者进行鼻窦手术时，发现在鼻窦手术后这些症状仍然存在，尤其是在没有鼻部症状或鼻窦内窥镜下无迹象表明存在副鼻窦炎的情况下。
本综述基于 2011 年 11 月 30 日进行的文献检索。使用“面部疼痛”的主题词（即鼻窦炎、偏头痛、丛集性头痛、中面部疼痛、三叉神经痛、阵发性偏头痛、持续性偏头痛和药物依赖型头痛），在 MEDLINE、EMBASE 和 Cochrane 数据库中进行了检索。检索仅限于英语文献。阅读摘要后，还对选定文章中的相关参考文献进行了综述。
文献回顾表明，头痛很少由鼻窦炎引起。同样，只有一小部分面部疼痛患者患有鼻窦炎，且这些患者要么患有急性鼻窦炎，要么患有慢性脓性鼻窦炎的急性加重。重要的是，大多数慢性鼻-鼻窦炎患者很少出现面部疼痛，除非他们发生急性感染或遭受气压创伤。由于无症状患者的 CT 扫描普遍存在偶发变化，因此不应对面部疼痛常规进行 CT 扫描。手术很少适用于慢性面部疼痛的治疗。
对疼痛及其相关症状进行结构化的病史回顾、鼻内窥镜检查和相关的针对性检查，应有助于做出正确的诊断和选择适当的治疗方法。
