Chronic Headaches and Facial Pain

University of Washington, Otolaryngology Grand Rounds, March 25th, 2009

6:30 am – Patricia Oakes, MD, Acting Instructor, Neurology “Chronic Headaches and Facial Pain”

In one of the UW meeting rooms where OTO-NHS Grand Rounds are held there is a fire door with a sign that reads, “Do not block.” It seems each Wednesday morning, a folded side-lying table creeps further and further in front of this emergency exit. This morning, it was completely blocking the way out. Fantasies of 20 residents and faculty tripping over each other to get out as fire licked at the main entrance flickered in my mind as I sat and gazed into the texture of the table. I began thinking this is an interesting metaphor for what happens in the nose and sinus passageways.

The emergency exit can be compared to the rhinosinus outflow system known as the ostiomeatal complex. This is the point where the frontal and maxillary sinuses normally drain into the nasal cavity. Obstruction here produces inflammation of the affected sinuses and is routinely treated with anti-inflammatory drugs and endoscopic sinus surgery. One of the great benefits of the REST treatment offered at Nova Sinus Center is that it promotes clearing of the ostiomeatal complex by supporting muco-ciliary drainage. When this emergency exit is clear, flow from the sinus ostia (openings from the sinuses into the nose passages) is enhanced. REST combines this benefit with microbicidal and biofilm reduction leading to prevention or resolution of ostiomeatal blockages. Next week, I think I’ll take some initiative and move that table out of the way.

Dr. Patricia Oakes was on hand today to present some pearls on headache of neurologic origin. She reviewed the ICHD-2 (International Headache Classification, 2ed) and placed special focus on migraine identification and differentiation of migraine from headaches of sinus origin. Dr. Oakes presented a study that concluded 86% of patients who thought they had sinus headaches actually had migraines. Despite Dr. Oakes’ admitted potential for diagnosis bias, this study was a real eye-opener for me. She went on to present differential diagnosis including the more dangerous causes of headache like stroke and artery dissection. In the end, I discovered a more refined appreciation of the causes of headache and when neurologic consult is indicated.

Frank Aversano, ND is an attendee of the University of Washington’s OTO-HNS Grand Rounds. He stays up to date on the latest drug and surgical procedures for the nose and sinuses.

I’d like to Schedule a Sinus Ninja treatment with Dr. Frank

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