·
nose allergy,
·
a bent nasal septum blocking the sinus opening or in contact with
the
opposite nasal lining, · a narrowed sinus opening/s with a sinus infection and
· an obstructed sinus with a negative sinus pressure
Sometimes
possibly all of the above can be present in the same person at the same time.
All of these conditions can stimulate and irritate the trigeminal nerve, which
then generates the headache that we feel.
Treatment
begins with the correct diagnosis. A full external and internal endoscopic
examination of the nose should be undertaken. In instances when a sinus-related
cause is suspected e.g. facial pains above, behind and below the eyes, and at
the top of the head, a CT scan of the sinuses can exclude sinus disease. X-ray
of the sinuses are traditionally undertaken but for a more comprehensive
picture, CT scans provide a great deal more information as well as serve as the
roadmap for sinus surgery should that be required.
Usually common
things happen commonly, and by far the commonest nasal cause of a headache is
inflammation of allergy or infection. If infection is seen, a simple course of
antibiotics can be undertaken. Nasal allergy is easily treated also by avoiding
the allergen e.g. house dust or pollen, saline nasal irrigation, topical nasal
steroids and/or antihistamines. The reduction in the inflammation desensitizes
the nasal lining as well as reduces the possibility of nasal lining contact and
sinus obstruction.
Perhaps the
next most likely cause for nasal irritation is when two opposing nasal linings
touch one another forming a trigger point. This is likely to occur when the
nasal septum is bent inside the nose. Often the patient would be aware of the
bent septum as they are aware of a blocked nose, more on one side than the
other although both may be equally blocked.
Sometimes a
frank sinus infection is seen on endoscopy. Then antibiotic treatment with
nasal decongestants also, would normally suffice, as sinus surgery is not the
usual first line treatment modality. However in situations when the sinus
condition becomes chronic without relenting or recurrent, then usually a more
permanent solution to re-open the sinus drainage and re-vent the sinuses may be
indicated. Nowadays, sinus surgery is extremely high tech, using endoscopes for
minimally invasive surgery. Surgery is targeted at re-opening the natural
openings of the sinuses. To make the surgery even less traumatic, when
appropriate, the sinus openings can be re-dilated with inflatable balloons;
this technique is known as balloon sinuplasty.
So to
summarize, nose and sinus-related headaches are not altogether that uncommon
especially today in our polluted modern world. It should be differentiated from
all the other causes of headaches by its picture. Treatment of these headaches
are usually very successful once the correct diagnosis has been established, as
there is often a triggering point that fires off the nerve-endings of the
trigeminal nerve that gives us these so-called Sluder’s headaches. You can
almost imagine Dr. Sluder himself having a bad headache when he first described
it too!
The Chinese version of this article was published in Hong Kong Economic Journal on 5 Jan 2015
