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Headache in Otolaryngology: Rhinogenic and Beyond, An Issue of Otolaryngologic Clinics of North America, E-Book

Headache in Otolaryngology: Rhinogenic and Beyond, An Issue of Otolaryngologic Clinics of North America, E-Book

Howard Levine

(2014)

Abstract

Patients present to physicians with headache or facial pain and are certain that it is a “sinus headache.” Specialists of all types - otolaryngologists, allergists, neurologists, internists, and emergency physicians are confronted almost daily with these patients. “Headache in Otolaryngology: Rhinogenic and Beyond” describes headaches ascribed to other causes - migraine as well as headaches that actually are a result of sinusitis. This volume addresses the need for expertise of an otolaryngologist who can obtain a history of nasal and sinus disease, evaluate the interior of the nose, and correlate it to a computed tomographic (CT) scan, along with collaboration of neurologists/headache specialists. Because headaches are often a symptom of potentially dangerous medical conditions that may need emergency work-up and referral to the appropriate physician, information in this volume identifies these emergency conditions for the clinician. Topics include: Confusion about sinus headache; Diagnosing Adult and Pediatric Headache; Imaging for the headache patient; TMJ head pain; Signs of dangerous headache; Vertiginous headache; Rhinogenic headache; Medical treatment of headache; and Surgery for headache.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Headache in Otolaryngology:Rhinogenic and Beyond i
copyright\r ii
Contributors iii
Contents v
Otolaryngologic Clinics\rOf North America\r ix
Preface\r xi
Why the Confusion About Sinus Headache? 169
Key points 169
Case example 171
Discussion 172
Summary 173
References 174
Diagnosing and Understanding Adult Headache 175
Key points 175
Tension-type headache 176
Case Presentation 177
Migraine 178
Imaging for Headache 187
Key points 187
Introduction 187
Definitions 188
Symptom criteria 189
Imaging 189
Septal Spur Abutting the Inferior Turbinate 190
Septal Spur Abutting the Middle Turbinate 190
Concha Bullosa of the Middle Turbinate 190
Concha Bullosa of the Superior Turbinate 190
Haller Cell 191
Small Infundibular Widths 192
Paradoxic Middle Turbinates 192
Atelectatic Maxillary Sinus 193
Summary 194
References 194
Imaging for Headache 197
Key points 197
Introduction and overview 197
Basic imaging anatomy and standard imaging techniques 197
Anatomic variants that may predispose to rhinogenic headache 199
Septal Variants 200
Concha Bullosa 200
Uncinate Variants 200
Ethmoid Variants 200
Rhinogenic Headache in the Absence of Sinusitis 201
Infectious or inflammatory 201
Findings of Acute Versus Chronic Sinusitis 201
Mucous Retention Cyst 204
Odontogenic Sinusitis 205
Polyps and Polyposis 205
Mucocele 207
Fungal Infection 208
Granulomatous Infection 208
Intracranial and Orbital Complications 209
Nasal and paranasal masses 216
References 219
Medical Management of Adult Headache 221
Key points 221
Introduction 221
Episodic migraine 222
Acute Treatment 222
Newer Acute Treatments 222
Preventive Treatments 224
Cluster headache 224
Acute Treatment 224
Preventive Treatment 227
Therapeutic Options in Treatment-Resistant Cluster Headache 228
Treatment of chronic daily headache 228
MO Headache and Acute Treatments 229
Preventive Treatment of CM 230
Antidepressants in CM and Chronic TTHA 231
Treatment of Tension Headache 232
Summary 233
References 233
What the Nonneurologist Can Do to Treat Headache 239
Key points 239
Overview 239
Primary and secondary headache types 240
Brain imaging in headache disorders 241
Migraine 242
Migraine Treatment 245
Lifestyle modification 245
Acute pain medication 245
Preventive medications 247
Tension-type headache 248
Episodic Tension-Type Headache 249
Cluster headache and other trigeminal autonomic cephalalgias 249
Secondary headaches 251
Summary 252
References 252
What Do We Know About Rhinogenic Headache? 255
Key points 255
Relevant nasal anatomy 257
Relevant neurophysiology 258
Relevant psychobiology 258
Primary headaches and rhinogenic headache 258
The problem of comorbidity 259
Rhinogenic headaches 259
Headache Attributed to Acute Rhinosinusitis 259
CRS 259
Mucosal contact point headache 260
Surgery for migraine relief? 262
Patient management 263
Summary 264
References 266
Evaluation and Management of “Sinus Headache” in the Otolaryngology Practice 269
Key points 269
Introduction 269
Diagnostic criteria 270
Establishing diagnosis 271
Recommending treatment 281
A Caveat 285
Summary 285
References 285
Red Flags and Comfort Signs for Ominous Secondary Headaches 289
Key points 289
Primary versus secondary headache 290
Taking a headache history 291
The 5 Ps 291
Pattern 291
Phenotype 292
Patient Factors 292
Pharmacology 292
Precipitating/Provoking Factors 292
Physical Examination 293
Diagnostic testing 293
Imaging Studies 293
Laboratory Testing 293
Warning Signs, Caution Signs, and Comfort Signs 293
Assigning the causality of a headache to a disorder 295
The importance of follow-up examination 295
Ominous red flags 295
Ominous Headaches Associated with Abrupt Onset 295
Ominous Headaches Associated with Trauma 296
Ominous Headaches Associated with CNS Infections 296
Ominous Headaches in Patients More than 50 Years of Age 296
Hypertensive crisis and headache 296
Ominous headaches associated with pregnancy and the postpartum period 297
Secondary Headaches: Important but Less Ominous 297
Medication overuse headache 297
Orthostatic headaches 297
Summary 298
References 298
The Essential Role of the Otolaryngologist in the Diagnosis and Management of Temporomandibular Joint and Chronic Oral, Hea ... 301
Key points 301
Introduction 302
Pitfalls leading to misdiagnosis of COHFP 302
Inflammatory/Degenerative Temporomandibular Joint Disorders Initially Presenting with Symptoms of Otalgia 303
Discussion Case 304
Neoplasia Misdiagnosed as COHFP and Temporomandibular Joint Disorders 306
Temporomandibular joint and masticatory muscle disorders: current concepts of diagnosis and management 308
Pathogenesis of Inflammatory/Degenerative Temporomandibular Joint Disorders 310
Internal derangement theory: a flawed approach to temporomandibular joint disorders 310
Maladaptive changes in synovial joints 311
The clinical evaluation 311
Principles of Nonsurgical Management of Inflammatory/Degenerative Temporomandibular Joint Disorders 316
Reduction of joint loading 317
Maximize joint mobility 317
Reduction of inflammation and pain 317
Recognize and treat masticatory muscle disorders 319
Relationship Between TMDs and Headache 319
Principles of Surgical Management of Temporomandibular Joint Disorders 319
Surgical outcomes 321
Postoperative rehabilitation 324
Other disorders affecting the temporomandibular joint of special interest to the otolaryngologist 325
Radiation Fibrosis 325
The Relationship Between Tinnitus and TMDs 326
Summary: The Essential Role Of The Otolaryngologist In Diagnosis And\rManagement Of Temporomandibular Joint And Cohfp Disorders: A Team\rApproach\r 327
References 328
Vertiginous Headache and Its Management 333
Key points 333
Overview 333
Migraine-Associated Vertigo 334
Motion Sickness 334
Visual-Vestibular Mismatch 334
Diagnostic Criteria for MAV 335
Diagnosis 335
Treatment 337
Exercise 1—Fist Passes 337
Exercise 2—Slow Head Rotations 338
Exercise 3—Convergence Jumps 338
Long-term prognosis 339
Summary 339
Acknowledgments 340
References 340
The Neurosurgical Treatment of Neuropathic Facial Pain 343
Key points 343
Case history 343
Introduction 344
Why Sinus Surgery for Pain Fails to Relieve that Pain, and Why Seemingly Successful Rhinologic Surgery Leads to Chronic Fac ... 344
Important Points 344
Definitions 344
Evaluation of the Patient with Facial Pain 345
Imaging 346
Diagnosis 346
Microvascular Decompression 346
Ablative Procedures 347
Neuromodulation 347
Radiosurgery 348
References 348
Index 351