Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Department of Otolaryngology, William Beaumont Hospital, Royal Oak, MI.
Int Forum Allergy Rhinol. 2019 May;9(5):443-451. doi: 10.1002/alr.22268. Epub 2019 Jan 15.
Although some causes of rhinogenic headache, such as acute sinusitis, have clear diagnostic criteria, others, such as "sinus headache" and mucosal contact points, are more nebulous. Misdiagnosis of these entities and primary headaches may result in unnecessary medical or surgical treatment. The purpose of this systematic review is to delineate current understanding of diagnosis and treatment of rhinogenic headaches, including sinus and mucosal contact point headaches, in children.
PubMed, SCOPUS, and the Cochrane databases were searched for studies on sinus headache and mucosal contact point headaches in children. Studies were assessed for level of evidence, and risk of bias was assessed by Methodological Index for Non-Randomized Studies (MINORS) scoring. Diagnostic criteria, management strategies, and other clinical data were analyzed.
Eight studies met the inclusion criteria. Level of evidence was predominantly 4. Forty percent of pediatric patients with migraine had been previously misdiagnosed with sinus headache. Of 327 pediatric patients in two studies, between 55% and 73% had at least 1 cranial autonomic symptom associated with their migraine. For children with mucosal contact point headaches, surgical management in select patients improved headache intensity or severity in 17 (89%) cases.
The majority of pediatric patients with sinus headache harbor a primary headache disorder, with migraine being most common. Physicians should suspect primary headache disorders in pediatric patients with chronic headaches and a normal exam. Although some case series are supportive of surgical management for mucosal contact point headaches in children, the level of evidence supporting these recommendations is insufficient. High-quality clinical trials are necessary for continuing to improve outcomes in patients with these clinical entities.
尽管一些鼻源性头痛的病因，如急性鼻窦炎，具有明确的诊断标准，但其他病因，如“鼻窦性头痛”和黏膜接触点，则较为模糊。这些实体和原发性头痛的误诊可能导致不必要的医疗或手术治疗。本系统评价的目的是阐述儿童鼻源性头痛（包括鼻窦性头痛和黏膜接触点头痛）的诊断和治疗现状。
在 PubMed、SCOPUS 和 Cochrane 数据库中检索关于儿童鼻窦性头痛和黏膜接触点头痛的研究。评估研究的证据水平，并通过非随机研究方法学指数（MINORS）评分评估偏倚风险。分析诊断标准、管理策略和其他临床数据。
符合纳入标准的研究有 8 项。证据水平主要为 4 级。40%的偏头痛儿童曾被误诊为鼻窦性头痛。在两项研究的 327 名儿科患者中，55%至 73%至少有 1 种与偏头痛相关的颅自主神经症状。对于患有黏膜接触点头痛的儿童，在一些选择的患者中，手术治疗可改善头痛的强度或严重程度，17 例（89%）患者得到改善。
大多数患有鼻窦性头痛的儿科患者存在原发性头痛疾病，其中偏头痛最常见。对于慢性头痛且体格检查正常的儿科患者，医生应怀疑原发性头痛疾病。尽管一些病例系列研究支持对儿童黏膜接触点头痛进行手术治疗，但支持这些建议的证据水平不足。需要进行高质量的临床试验，以进一步改善这些临床实体患者的结局。
