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Headache in ENT

Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon.

Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.

“Doctor, I have headache, they told me it might be my sinuses………” this is a very common complaint in the ENT clinic.

Headache is a very complicated problem in general, people are complaining of headache for many reasons and they describe headache in many ways and fail to describe it in many ways!!

I was writing and rewriting this article for many days till I decided to rewrite it again and make it simple straight forward facts about headache without going so deep in the dilemma of headache diagnosis because the main idea of this articles collection is to make ENT simple to patients, and we will keep the dilemma to the doctors scientific meetings.

Headache is the pain in the head, could happen anywhere in the head, and could be caused by many problems including neurological, ophthalmic, dental, sinus, oral, ear and general body problems including vitamins deficiency, blood pressure, hormonal problems, and blood sugar changes, could be caused by work stresses, by over exhaustion, and by psychological problems.

Headache could be transient and simple, and could be chronic, in this article I am speaking about the chronic recurrent headache.

I will leave non ENT causes of headache for people specialized in it to speak about, but I feel an urge to mention something related to neurological causes of headache that I feel it’s getting very commonly miss understood by patients: very commonly, I get this statement by patients who are rotating between clinics trying to diagnose their headache:”Doctor, it’s not the brain nor the nerves, I underwent MRI scan and it was normal!”, MRI or Ct scans might rule out hemorrhage, tumor, infarction, or vascular abnormalities, but this doesn’t mean that the patient does not have migraine, tension headache, cluster headache or other headache related neurological syndromes, all these problems are not seen by scans, they are rather diagnosed by a detailed clinical evaluation.

ENT causes for headache can be subdivided into causes related to the nose and sinuses and causes related to the ear. Ear pain is discussed in another article in which I clarified the possibility of having pain in the ear while the cause might not be the ear due to the common innervation of the ears with teeth , TMJ, and throat (refer to ear pain article). We can say the same here about headache on the sides of the head and around the ear area; causes are generally the same causes for ear pain.

Nose and sinus causes are due to narrowing of the sinus openings due to infection, polyp, allergy or any cause of nose block (please see nose block in adults article). Sinus headache usually comes in the area between eyes, below the eyes, or above eyes, it can come in other places but these are the typical places of sinus headache, it usually comes with nose block and /or nasal secretions, loss of smell, or other nasal symptoms of allergy like sneezing and itching, the pain usually increases with putting the head front and down in forward leaning position, pressure usually is felt around the eyes due to their close relation. We can diagnose sinus problems by clinical evaluation, but if we want to be sure we might need to ask for CT scan for the sinuses to see the sinuses from inside. Some common anatomical variations are considered sometimes as causes of headache even without the presence of sinusitis including touching areas in the sinuses due to what is called concha bollusa (presence of air cavity within the middle turbinates).

While we can easily diagnose sinus problems, we will always have difficulties proving that this problem is the actual cause for the pain, because simply the patient might have simple sinusitis but he/she is complaining also of migraine for example. My approach always includes complete evaluation of the problem, followed by detailed explanation of the relation between the problem and the patient’s headache, clarifying all possibilities. We can always treat any problem we face even if appeared after treatment that it’s not the cause of the headache as long as we are treating with non invasive medical treatment with no major side effects. I am always hesitant to correct minor sinus problem surgically to relieve headache even if there is a possibility that it’s the cause of the headache because I can’t give a guarantee to the patient that the pain will go away after correction.

Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon.

Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.