Lal Devyani, Rounds Alexis B, Rank Matthew A, Divekar Rohit
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ.
Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Phoenix, AZ.
Int Forum Allergy Rhinol. 2015 May;5(5):408-16. doi: 10.1002/alr.21502. Epub 2015 Mar 6.
The objective of this work was to study patient and 22-item Sino-Nasal Outcome Test (SNOT-22) characteristics in primary headache disorders (PHDs).
Retrospective chart review of "sinus" headache/pressure/pain patients was conducted. Patients that had rhinosinusitis excluded (negative endoscopy/computed tomography [CT]), and neurologist-confirmed PHD were studied. Patterns in symptom and SNOT-22 items were analyzed by network visualization and cluster analysis.
Forty-six patients met study criteria. Forty-three (93.5%) reported "need to blow nose" and 40 (86.9%) reported postnasal drainage. Sneezing was reported by 37 (80.4%) patients, "blockage/congestion of nose" by 33 (71.8%), and "runny nose by 32 (69.6%) patients. The median SNOT-22 score was 54 (interquartile range [IQR], 40 to 63). Past history included neurological diagnoses (60%), rhinologic disease (39%; chronic rhinosinusitis [CRS], rhinitis, recurrent acute sinusitis), asthma (28%), and allergen-sensitivity (26%). Previous sinonasal surgery had been performed in 41%. Network layout and cluster analysis identified 2 patient clusters and 2 symptom clusters. Two-thirds (31) of patients formed a tight cluster (cluster 1) linking to a symptom cluster of psychosocial items wrapped tightly with "facial pain/pressure." The remaining one-third of patients (cluster 2) linked to rhinologic symptoms loosely grouped away from "facial pressure/pain." In contrast to patients in cluster 2, patients in cluster 1 were predominantly female (p < 0.04), had significantly higher (p < 0.0001) median SNOT-22 scores (60 vs 34; IQR, 53 to 67 vs 17 to 42), were more likely to have migraine history (p = 0.058), and reported being "sad" (p < 0.0001) or "embarrassed" (p < 0.006).
Prominent rhinologic symptoms can be present in PHD patients in the absence of rhinosinusitis. In particular, high symptom-burden/SNOT-22 scores and high psychosocial symptoms should raise suspicion of PHD when endoscopy and/or CT results do not correlate with symptoms.
本研究旨在探讨原发性头痛疾病（PHD）患者的情况以及22项鼻-鼻窦结局测试（SNOT-22）的特征。
对“鼻窦”头痛/压痛/疼痛患者进行回顾性病历审查。排除患有鼻窦炎的患者（内镜检查/计算机断层扫描[CT]结果为阴性），研究经神经科医生确诊的PHD患者。通过网络可视化和聚类分析对症状和SNOT-22项目的模式进行分析。
46例患者符合研究标准。43例（93.5%）报告有“需要擤鼻”症状，40例（86.9%）报告有鼻后滴漏。37例（80.4%）患者报告有打喷嚏症状，33例（71.8%）报告有“鼻塞”，32例（69.6%）患者报告有“流涕”。SNOT-22评分中位数为54（四分位间距[IQR]，40至63）。既往病史包括神经科诊断（60%）、鼻科疾病（39%；慢性鼻窦炎[CRS]、鼻炎、复发性急性鼻窦炎）、哮喘（28%）和过敏原敏感性（26%）。41%的患者曾接受过鼻窦手术。网络布局和聚类分析确定了2个患者聚类和2个症状聚类。三分之二（31例）患者形成一个紧密聚类（聚类1），与一个心理社会项目的症状聚类紧密相连，该症状聚类与“面部疼痛/压痛”紧密相关。其余三分之一的患者（聚类2）与鼻科症状相关，这些症状松散地聚集在一起，远离“面部压痛/疼痛”。与聚类2中的患者相比，聚类1中的患者以女性为主（p<0.04），SNOT-22评分中位数显著更高（p<0.0001）（60对34；IQR，53至67对17至42），更有可能有偏头痛病史（p=0.058），并报告有“悲伤”（p<0.0001）或“尴尬”（p<0.006）情绪。
在没有鼻窦炎的PHD患者中可能存在明显的鼻科症状。特别是，当内镜检查和/或CT结果与症状不相关时，高症状负担/SNOT-22评分和高心理社会症状应引起对PHD的怀疑。
