Comprehensive Role of Otorhinolaryngologists in the Management of Headache: A Prospective Tertiary Care Centre Based Study

Background: Headache is most common complaint of human being. Classified into primary (migraine, tension headache and trigeminal neuralgia) and secondary (infectious, vascular and drug induced). Sinugenic headache is deep seated, dull aching with fullness and heaviness in sinus area. The purpose of study to assess the comprehensive role of otorhinolaryngologists in the diagnosis of headache and to evaluate the efficacy of medical and surgical management of patients presented with headache. 200 patients reported to rhinology clinic with headache. Detailed history, head and neck examination routine blood investigation, fundus examination & anterior rhinoscopy, radiological investigations X-ray paranasal sinuses, skull & cervical spine and direct nasal endoscopy was and CT paranasal sinus preoperatively done.

Results: 200 patients assessed using VAS analog scale before and after treatment dividing into four groups: resolved, improved, no change, and worsened’ group; p value was statistically significant in resolved and improved group whereas non-significant in no change and worsened group. 129 patients had non-sinugenic headache; 29(22.48%) with cervical cause, Migraine 24 (18.60%) and ophthalmic 23 (17.48%) respectively; dental and vascular 19 (14.72%) each, and psychogenic headache in 13 (10.07%) and trigeminal neuralgia in 2 patients (1.55%). 96.12 % were relieved by medical treatment whereas 71 patients of sinugenic headache 21.12% were treated successfully with medical treatment. One refused surgery, 50/55 (90.90%). Improvement assessed by SNOTT-22 pre- and post-surgery that was statistically significant p value-0.002.

Conclusion: Headache need comprehensive management. Sinugenic headache managed successfully initially with medical treatment and refractory cases by surgical intervention with equal efficacy.

Keywords:Sinugenic headache; Otorhinolaryngologists; SNOTT-22; Contact point headache

Abbreviations:VAS score: Visual Analogue; SNOTT-22: Sino Nasal Outcome Test; BT: Bleeding time; CT: Clotting Time; CTPNS: Computed Tomography Scan Of Para Nasal Sinuses; HIS: International Headache Society; DNS: Deviated Nasal Septum