Jayawardena Asitha D L, Chandra Rakesh
From the Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee.
Am J Rhinol Allergy. 2018 Jan 1;32(1):12-15. doi: 10.2500/ajra.2018.32.4501.
"Sinus headache" is a common chief complaint that often leads patients to an otolaryngologist's office. Because facial pain may or may not be sinogenic in origin, the otolaryngologist should be equipped to evaluate and treat or to appropriately refer these patients. Analysis of current data indicates that the majority of patients who present with sinus headaches actually have migraines. Furthermore, the downstream effect of the cytokine cascade initiated in migraine physiology can cause rhinologic symptoms, including rhinorrhea, congestion, and lacrimation, which may also confound diagnosis. Other causes of sinus headache include the following: cluster headaches, Sluder neuralgia, trigeminal neuralgia, myofascial trigger point pain (tension headaches, temporomandibular joint dysfunction), and contact point headaches. The diagnostic dilemma for an otolaryngologist occurs when a patient has facial pain and symptoms that may indicate chronic rhinosinusitis but with nondiagnostic endoscopy. Traditionally, these patients have been primarily managed with empiric antibiotics. An alternative strategy is to first screen these patients with an upfront computed tomography. This algorithm may ultimately decrease cost; avert unnecessary antibiotics prescriptions; and prompt more timely referrals to other, more appropriate, disciplines, such as neurology, dentistry, and/or pain management specialists.
“鼻窦性头痛”是一种常见的主要症状，常使患者前往耳鼻喉科医生的诊室。由于面部疼痛的起源可能是鼻窦性的，也可能不是，耳鼻喉科医生应具备评估和治疗这些患者的能力，或能适当地将他们转诊。对当前数据的分析表明，大多数表现为鼻窦性头痛的患者实际上患有偏头痛。此外，偏头痛生理过程中引发的细胞因子级联反应的下游效应可导致鼻科症状，包括鼻漏、鼻塞和流泪，这也可能混淆诊断。鼻窦性头痛的其他原因包括：丛集性头痛、斯路德神经痛、三叉神经痛、肌筋膜触发点疼痛（紧张性头痛、颞下颌关节功能障碍）和接触点头痛。当患者出现面部疼痛和可能提示慢性鼻-鼻窦炎的症状，但鼻内镜检查无诊断意义时，耳鼻喉科医生就会面临诊断困境。传统上，这些患者主要采用经验性抗生素治疗。另一种策略是首先对这些患者进行术前计算机断层扫描筛查。这种方法最终可能会降低成本；避免不必要的抗生素处方；并促使更及时地转诊到其他更合适的科室，如神经科、牙科和/或疼痛管理专家。
