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Suzaki I, Miyoshi N, Ishima T, Hirano K, Shimane T. Successful Omalizumab Treatment of Rhinogenic Contact Point Headache Complicated by Severe Cedar Pollinosis: A Case Report. Cureus 2023; 15:e51046. [PMID: 38264387 PMCID: PMC10805559 DOI: 10.7759/cureus.51046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
Headache is one of the most common neurological disorders in children. The most common headache in children is a primary headache, including migraine and tension-type headache, but note that secondary headaches should be differentiated as a cause of headache in pediatric patients. The management of cedar pollinosis in pediatric patients is important because it can cause quality-of-life deficits in addition to nasal and ocular symptoms. Omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, is approved in Japan as an add-on treatment option for severe cedar pollinosis, but few studies have investigated its real-world clinical efficacy in pediatric patients with seasonal allergic rhinitis. We report the case of a 15-year-old male patient with cedar pollinosis who suffered from uncontrolled naso-ocular symptoms, facial pain, and headache despite using histamine H1-receptor antagonists and intranasal corticosteroid spray. A sinus computed tomography scan and nasal endoscopic findings showed a swollen inferior turbinate and nasal septum in contact with the nasal cavity ipsilateral to the headache. Application of local anesthesia to the contact points within the nasal cavity resulted in the rapid relief of headaches. Therefore, we diagnosed rhinogenic contact point headache triggered by cedar pollinosis and initiated the add-on therapy of omalizumab for seasonal allergic rhinitis. Three days after the administration of omalizumab, his naso-ocular symptoms, quality-of-life deficits, and headache improved markedly, accompanied by improved nasal endoscopic findings. Omalizumab was immediately effective for the treatment of rhinogenic contact point headaches complicated by severe cedar pollinosis in a pediatric patient.
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Affiliation(s)
- Isao Suzaki
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Naoto Miyoshi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Takahiro Ishima
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Kojiro Hirano
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
| | - Toshikazu Shimane
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Showa University, Tokyo, JPN
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Folic MM, Barac AM, Ugrinovic AB, Jotic AD, Trivic AS, Milovanovic JP, Borozan NN, Peric AR, Stevanovic G, Krejovic-Trivic SB, Cvorovic L, Stojkovic GM. Effectiveness of the Treatment of Rhinogenic Headache Caused by Intranasal Contact. EAR, NOSE & THROAT JOURNAL 2023; 102:605-610. [PMID: 34077274 DOI: 10.1177/01455613211019706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of the study is to evaluate the effectiveness of the surgical and nonsurgical treatment of headache caused by contact points (CPs) between the nasal septum and inferior or middle turbinate. METHODS The research was designed as a prospective clinical case-series study. The patients with CP headaches were offered to choose between 2 treatment options, surgery and medical treatment. Two groups of surgically treated patients (surgery groups 1 and 2, depending on whether there is a contact between nasal septum and inferior turbinate or middle turbinate) were evaluated and compared for headache intensity and frequency. Headache intensity was measured using a visual analog scale value from 0 to 10; the frequency of headache was expressed as the number of days during 1 month with a headache (before surgery, 1 month, and 6 months after surgery). A comparison was also made between surgically and nonsurgically treated patients. RESULTS We found more intensive and frequent headache in patients who had CP between the nasal septum and the middle turbinate (P = .038 and P = .003, respectively). A significant reduction in headache intensity and frequency was found in both groups of surgically treated patients 6 months after surgery; however, this reduction was more significant in patients with mucosal contact between nasal septum and middle turbinate. The nonsurgical treatment made a significant reduction of headache intensity and frequency at 1-month follow-up (P = .012 and P = .031, respectively), but not at 6-month follow-up (P = .114 and P = .088, respectively). CONCLUSION Surgery gave a statistically significant reduction in the intensity and frequency of headache, which was assessed 6 months after surgery. Surgery was found as superior to nonsurgical treatment in the therapy of CP headache.
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Affiliation(s)
- Miljan M Folic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra M Barac
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Aleksandar B Ugrinovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana D Jotic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandar S Trivic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Jovica P Milovanovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | | | - Aleksandar R Peric
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Goran Stevanovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja B Krejovic-Trivic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Ljiljana Cvorovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Goran M Stojkovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
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Patel VA, Liaw J, Saadi RA, Isildak H, Polster SP, Kalmar CL. Headache Diagnosis in Children and Adolescents. Otolaryngol Clin North Am 2022; 55:633-647. [PMID: 35490042 DOI: 10.1016/j.otc.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric headache is a common medical complaint managed across multiple subspecialties with a myriad of unique factors (clinical presentation and disease phenotype) that make accurate diagnosis particularly elusive. A thorough understanding of the stepwise approach to headache disorders in children is essential to ensure appropriate evaluation, timely diagnosis, and efficacious treatment. This work aims to review key components of a comprehensive headache assessment as well as discuss primary and secondary headache disorders observed in children, with a particular focus on clinical pearls and "red flag" symptoms necessitating ancillary diagnostic testing.
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Affiliation(s)
- Vijay A Patel
- Division of Otolaryngology - Head & Neck Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard MS #58, Los Angeles, CA 90027, USA.
| | - Jeffrey Liaw
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri, Columbia, MO, USA
| | - Robert A Saadi
- Department of Otolaryngology - Head & Neck Surgery, University of Arkansas, Little Rock, AR, USA
| | - Huseyin Isildak
- Department of Otolaryngology - Head & Neck Surgery, Stony Brook University, East Setauket, NY, USA
| | - Sean P Polster
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher L Kalmar
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Swain S. Rhinogenic contact point headache – A review. MATRIX SCIENCE MEDICA 2022. [DOI: 10.4103/mtsm.mtsm_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rhinogenic and sinus headache - Literature review. Am J Otolaryngol 2021; 42:103113. [PMID: 34175774 DOI: 10.1016/j.amjoto.2021.103113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Headache is a common, yet challenging symptom to evaluate given its wide range of clinical presentations and different etiologies. For centuries, conceptual understanding of headache causation has been attributed to anatomic abnormalities of the nose and paranasal sinuses. METHODS Structured literature review. RESULTS The number of cases, categorized as migraines or other primary headaches, misdiagnosed as a "sinus headache" is high in the literature, ranging from 50 to 80%. The potential mechanisms for rhinogenic headaches were classically described as pain secondary to prolonged mucosal contact points, hypoxia in the paranasal sinuses secondary to poor ventilation, or pressure caused by the growth of nasal polyps. Additionally, other mechanisms were described and are still being studied. Corrective surgery for mucosal contact points in the nasal cavity is deemed necessary for relieving the headache, although patient outcomes are variable. CONCLUSION Delay in proper diagnosis and treatment negatively impact patient quality of life. Most cases of "sinus headache" or "rhinogenic headache" seen in clinical practice are in fact misdiagnosed as either primary headaches or migraines. Because of increased misdiagnoses, Otolaryngologists should establish a direct and precise diagnosis congruent with a chief complaint being a headache. Vital information such as a good clinical history, well-performed nasal endoscopy, and occasional CT scan may decrease misdiagnosis probability.
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In response to the 'Letter to the Editor' on the paper "Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis". Eur Arch Otorhinolaryngol 2021; 278:2169-2170. [PMID: 33860838 DOI: 10.1007/s00405-021-06808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
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Etiology of 'Sinus Headache'-Moving the Focus from Rhinology to Neurology. A Systematic Review. Brain Sci 2021; 11:brainsci11010079. [PMID: 33435283 PMCID: PMC7827425 DOI: 10.3390/brainsci11010079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
'Sinus headache and/or facial pain' (SH) is a common complaint encountered by otorhinolaryngologists, neurologists and general practitioners. However, several studies suggested that the majority of those cases may be attributed to primary headaches (i.e., migraine and tension-type headache (TTH). The purpose of this review is to evaluate the etiology of SH. The first part includes cross-sectional studies analyzing the prevalence of respective diagnoses in subjects with SH. The majority of these publications indicate that migraine and TTH are the most prevalent causes of SH, although most of these studies were conducted in a clinical setting. The second part of this review included treatment trials in subjects with SH. The findings from this part of the review show that SH without rhinosinusitis responds well to pharmacotherapy targeted at primary headaches. This observation further supports a neurologic etiology of the majority of SH cases.
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Pashkova AA, Svider PF, Eloy JA. Pain Management for the Otolaryngologist: Overview of Perioperative Analgesia and Introduction to Opioids. Otolaryngol Clin North Am 2020; 53:715-728. [PMID: 32682532 DOI: 10.1016/j.otc.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nearly 50,000 US adults experience opioid-overdose deaths annually and 1.7 million experience a substance use disorder from prescription opioids. Hence, understanding analgesia strategies is of utmost importance. A pre-operative analgesic plan can consist of a brief conversation between the surgeon, patient, and anesthesiologist in an uncomplicated case or range all the way to an involved, multidisciplinary plan for a chronic pain patient. Over the past several decades, there have been myriad studies examining perioperative analgesic regimens for otolaryngologic procedures, many of which have demonstrated the efficacy of nonopioid analgesics.
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Affiliation(s)
- Anna A Pashkova
- Division of Pain Medicine, Department of Anesthesiology, Columbia University Medical Center
| | - Peter F Svider
- Otolaryngology-Head and Neck Surgery, Bergen Medical Associates, Emerson, NJ, USA; Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100 Newark, NJ 07103, USA
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Lou Z. The rhinogenic headache resulting from the contact point between inferior turbinate and septal spur. Am J Otolaryngol 2019; 40:102281. [PMID: 31492515 DOI: 10.1016/j.amjoto.2019.102281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
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