Sollini Giacomo, Mazzola Francesco, Iandelli Andrea, Carobbio Andrea, Barbieri Andrea, Mora Renzo, Peretti Giorgio
Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genova, Italy.
J Craniofac Surg. 2019 Jul;30(5):1503-1505. doi: 10.1097/SCS.0000000000005239.
Rhinogenic headache (RH) is a widespread pain syndrome but its pathogenesis and treatment are still unclear. Some authors recognize a correlation between RH and mucosal contact points or some other sinonasal anatomical variations. The authors conducted a retrospective case-control study to analyze the correlation between radiological findings and clinical symptoms.One hundred-nineteen adults with Para-Nasal Sinuses Computed Tomography (PNS-CT) scans were included: 64 patients who have originally undergone PNS-CT scan as part of rhinogenic headache workup (Group A), and 55 controls in whom PNS-CT scans were obtained for other purposes (Group B). All subjects were asked to report their symptoms using a headache scoring system. PNS-CT scans of all subjects were analyzed for presence of mucosal contact points, middle turbinate concha bullosa (MTCB) and frontoethmoidal cells.The most common anatomical abnormality found in our series was MTCB, reported in 60.9% of patients in Group A and 41.8% of those in Group B. A statistically significant prevalence was found in Group A compared to Group B regarding the presence of MTCB (P = 0.037) and Type II (P = 0.016) and Type III (P = 0.039) frontoethmoidal cells. No statistically significant difference (P >0.05) was found between Group A and Group B regarding the presence of mucosal contact points at each site.Multiple anatomical variations in nasal and paranasal sinuses may cause a rhinogenic headache with different characteristics. Some of these, such as concha bullosa of middle turbinate or type II and III Kuhn cells, have shown a significant association with rhinogenic headache. No statistically significant association was found between presence of headache and mucosal contact points and type I and IV frontal cells. These findings can be very helpful for the surgeons that want to deal with the treatment of RH.
鼻源性头痛（RH）是一种广泛存在的疼痛综合征，但其发病机制和治疗方法仍不明确。一些作者认为RH与黏膜接触点或其他鼻窦解剖变异之间存在关联。作者进行了一项回顾性病例对照研究，以分析影像学检查结果与临床症状之间的相关性。
纳入了119例进行了鼻窦计算机断层扫描（PNS-CT）的成年人：64例最初因鼻源性头痛检查而接受PNS-CT扫描的患者（A组），以及55例因其他目的进行PNS-CT扫描的对照者（B组）。所有受试者均被要求使用头痛评分系统报告其症状。对所有受试者的PNS-CT扫描进行分析，以确定是否存在黏膜接触点、中鼻甲泡状鼻甲（MTCB）和额筛窦气房。
在我们的研究系列中发现的最常见解剖异常是MTCB，A组60.9%的患者和B组41.8%的患者报告有此异常。与B组相比，A组中MTCB的存在（P = 0.037）以及II型（P = 0.016）和III型（P = 0.039）额筛窦气房的患病率具有统计学意义。A组和B组在每个部位黏膜接触点的存在方面未发现统计学显著差异（P > 0.05）。
鼻腔和鼻窦的多种解剖变异可能导致具有不同特征的鼻源性头痛。其中一些，如中鼻甲泡状鼻甲或II型和III型库恩气房，已显示与鼻源性头痛有显著关联。头痛的存在与黏膜接触点以及I型和IV型额窦气房之间未发现统计学显著关联。这些发现对于想要处理RH治疗的外科医生可能非常有帮助。
