Headache Medicine 2020, 11(4):98 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.28

Headache Medicine

Commentary

Rhinosinusitis as a cause of headache

Diego Belandrino Swerts

Albert Einstein Faculty of Medicine, Neurology, São Paulo, São Paulo, Brazil

The article published by Ceriani and Silberstein

addresses, in the format of a systematic review, the

relationship between headache and rhinosinusitis, showing that most of these cases are over diag-

nosed in patients who actually have primary headaches, the majority being migraines. In addition,

the article emphasizes the underdiagnosed sphenoid rhinosinusitis which can have great morbidity

and even mortality.

The article reviews the concepts of acute rhinosinusitis (1 day to 4 weeks), recurrent acute respiratory

syndrome (ARS) (four or more episodes lasting 7 days in one year) and chronic rhinosinusitis (persistent

beyond 12 weeks). The article then discusses the morphological, etiological, diagnostic and treatment

review of these diseases.

Acute respiratory syndromes are mostly viral, with adenovirus, inuenza and parainuenza as the most

prevalent agents. Bacterial infections have as main agents

Streptococcus pneumoniae and Haemoph-

ilus inuenza

. The clinical presentation usually leads to purulent nasal discharge, accompanied by

nasal obstruction and/or pain pressure fullness. Altered sense of smell, cough, halitosis, dental pain,

pharyngitis, and otologic symptoms may be present.

Migraine symptoms, such as nausea, photophobia, phonophobia were seen in the minority of patients

in the studies. In addition, ARS headache is bilateral, in pressure with worsening frontal compression,

less common symptoms in primary headaches. In chronic respiratory syndrome (CRS), headache and

facial pain are even less common symptoms. The studies analyzed in the systematic review show that

primary headaches should always be considered in patients with rhinosinusitis, and most patients in

the studies ended up switching the diagnosis to primary headache after revaluation.

The article continues with a review of treatment of ARS cases, showing that symptomatic patients should

be the rst option, in cases with suspected bacterial agents, amoxicillin proved to be the rst-line treat-

ment, with association with clavulanate in patients with suspected resistance to amoxicillin (smokers,

diabetics, recent use of antibiotics), the treatment of CRS was indicated with topical corticosteroids

and saline wash.

Finally, the article discusses the importance of suspecting sphenoid rhinosinusitis, which can develop with

photophobia, lacrimation, cranial nerve palsies, fever, epistasis, and visual symptoms. The importance

of investigating for this condition is due to complications such as bacterial meningitis, sinus thrombosis,

abscess, hypophysitis that are associated with high morbidity and even mortality.

Thus, in a very well-written article, the authors go through the management of the patient with a previous

diagnosis of rhinosinusitis, reporting through the symptoms, the importance of reviewing the diagnosis

and suspecting primary headaches. In addition, it eases the management of these conditions, and

emphasizes the importance of excluding the diagnosis of sphenoidal rhinosinusitis in these cases.

References

Ceriani CE, Silberstein SD. Headache and rhinosinusitis: A review.

Cephalalgia

2021;41:453 -463

diegobelandrino@gmail.com

Received: October 7, 2020

Accepted: November 14,2020