What Causes Sinus Pressure and Pain?

Rhinogenous headache: refers to headache caused by nasal cavity and sinus disease. Acute inflammation of the sinuses is most common, accounting for about 5% of all headaches. Others such as acute, chronic rhinitis, chronic sinusitis, atrophic rhinitis, and deviated nasal septum can cause it.

Chinese name: Rhinogenic headache

Foreign name: rhinogenous headache
Department: ENT

Nasal headache

Nasal headaches usually have symptoms of rhinitis, such as nasal congestion, runny nose, etc., mostly deep headaches, dull or dull pain, non-pulsating, heavier during the day; relieved during bed rest, the headache has certain parts and At the time, when bowing down, the collar was too tight, and the whole body exerted pressure to increase the venous pressure, the nasal mucosa became congested and the headache worsened. After the nasal mucosa is contracted or the surface is anesthetized, the headache can be reduced.

Causes of nasal headache

Headache is a subjective symptom which is common in clinic, has many causes, and the mechanism is very complicated. Local lesions and structural changes in the nasal cavity and sinuses are closely related to the occurrence of headaches. Among them, headaches caused by rhinitis, sinusitis, and deviated nasal septum are more common. The causative factors of nasal headache are roughly divided into two categories. First, the nasal cavity is rich in sensory nerve fibers. The sensory nerves in the nasal cavity come from the ocular and maxillary branches of the trigeminal nerve. The branch of the eye divides the anterior ethmoidal nerve to the front of the nasal cavity, the branch of the maxillary branch divides the lateral branches of the posterior superior and posterior inferior nerve to the middle and lower turbinates, the anterior, middle and posterior branches of the upper alveolar to the maxillary sinus feel. At the same time, there are sympathetic and parasympathetic nerves in the nasal cavity, and the vasomotor contraction and glandular secretion of the nasal mucosa. Therefore, the nasal cavity is a sensitive part of the human body. Secondly, the nasal cavity is actually composed of narrow lumens, holes and gaps. The anatomical structure is complex and fine. Once it is affected by inflammation and the anatomical structure of the nasal cavity is enlarged and mutated, it may easily cause nasal and sinus drainage disorders and swelling. Pressure, causing adjacent structures to be affected. Early manifestations are obstructive headaches. Due to the long-term obstruction of the sinus ostium, the air in the sinus cavity is gradually absorbed, so-called "vacuum headaches" occur. In the vacuum state, the mucosal blood vessels dilate, a large amount of serum leaks out, or the sinuses leak due to inflammation Cavity pressure increased and "tension headache" appeared again. The deflection of the upper nasal septum and swollen ethmoids, ethmoidal vesicles, and turbinate swollen volume cause narrowing of the nasal cavity, especially the olfactory seam, and compression of the middle and lower turbinates, resulting in restricted headache and reflex headache. Inflammation of the nasal nerve is also one of the factors that cause headaches.

Nasal headache

1, generally have symptoms of rhinitis, such as nasal congestion, runny nose, etc .;

2. Pain is generally dull, faint, non-pulsating, heavier during the day, headache relieved after rest, and worsened after activity;

3. The pain has certain parts and timeliness;

4. After taking measures such as rest, nasal drops, steam inhalation, or nasal ventilation and drainage, headaches can be relieved or temporarily relieved. When coughing, bowing, bending down, and exerting force, the head venous pressure increases and the headaches become worse.

Clinical manifestations of nasal headache

1. Symptoms: headache with a clear temporal and fixed location, the headache location is the nasal root, forehead, temporal, parietal occipital or periorbital dull pain. Some are associated with eye symptoms such as swelling of the eyeballs, susceptibility to fatigue, and other eye symptoms; more often with nasal congestion, purulent sputum, and decreased smell. When the nasal mucosa is fully contracted and undergoes surface anesthesia, the pain is significantly relieved or disappeared.

2. Signs: Anterior nasal or endoscopic examination shows lesions in the nasal mucosa, turbinates, nasal passages or nasal septum, such as dark red nasal mucosa, congestive edema in the turbinate, purulent secretions in the nasal passages, nasal litchi meat-like new creatures, Nasal septum deflection, and even nasal tumors.

Rhinogenic headache imaging

Nasal and sinus CT examination is an important method to determine whether the nose and sinus are damaged.

Rhinogenic headache auxiliary examination

1. Nasal examination : Anterior nasal examination may show chronic congestion of the nasal mucosa, swelling or hypertrophy, hypertrophy or polyp-like changes in the middle turbinate, narrowing of the middle nasal passages, edema of mucous membranes, or polyps, etc. In the anterior group, sinusitis occurred in the middle nose. There is pus in the tract; pus from maxillary sinusitis is generally in the lower back of the middle nasal passage, and can flow down the inferior turbinate and accumulate in the bottom of the nasal cavity and the lower nasal passage. In frontal sinusitis, pus mostly drains from the anterior segment of the middle nasal passage. In the anterior group, ethmoid sinusitis was seen with thick pus in the middle nasal passage. Sinusitis pus in the back group drained from the olfactory fissure and accumulated in the back of the nasal cavity or into the nasopharynx. A post-nasal examination should be performed if necessary to help observe the upper nasal passages for pus. If ethmoid sinusitis is suspected and no pus is found in the nasal passages, 1% ephedrine can be used to contract the nasal mucosa for postural drainage to help diagnosis. Fibrous nasopharyngolaryngoscope or nasal-sinus endoscopy is used to assist in the examination, to observe the mucosal changes on the walls of the nasal cavity and the openings of the sinuses, as well as the secretions of the sinus mouth, which is more helpful for diagnosis.

2. Oral and pharyngeal examinations : If it is odontogenic maxillary sinusitis, lesions may be detected on the ipsilateral maxillary bicuspid or first and second molars. Sinusitis in the posterior group is sometimes seen with purulent discharge or dryness attached to the posterior wall of the pharynx.

3. X-ray sinus radiography and tomography : It is one of the important methods to diagnose sinusitis, but it should be combined with clinical symptoms to help diagnosis. When suffering from sinusitis, the mucosa in the sinus is thickened to different degrees, so the X-ray film can still show the size and shape of the sinus cavity, and it is more valuable for those who need surgery. If necessary, maxillary sinus iodine oil angiography is performed to better diagnose.

4. Sinus puncture irrigation or catheter irrigation method : The maxillary sinus, frontal sinus, and sphenoid sinus can be placed in the catheter through the sinus orifice for irrigation and perfusion of drugs. However, due to the complex anatomy, the operation technique is difficult, and it is often difficult to succeed. The sinus puncture and irrigation method is most commonly used in the maxillary sinus. The puncture of other sinuses is generally dangerous and is rarely used. The maxillary sinus puncture and irrigation can be used to understand the nature and amount of pus in the sinus, and whether it has a foul odor. It can also be used for bacterial culture and drug sensitivity tests to infer the degree of sinus lesions and develop treatment plans.

5. CT scan : When examining sinusitis, you can more clearly observe whether the sinus wall is damaged and the degree of sinus mucosal lesions.

6. Ultrasound of sinus sinus : It is a new diagnostic technique for maxillary sinus and frontal sinus examination. A-type ultrasound examination is non-invasive, simple, fast, and repeatable. Hydrops, polyps, or tumors can be found in the sinus cavity.

7. Maxillary sinus endoscopy : This test is the latest method for diagnosing lesions. It was used clinically in the 1970s. Pathological biopsies, or films and videos, can be taken in the sinuses under cold light illumination, which can overcome the blindness of the examination. To improve the diagnosis rate.

Classification and diagnosis of nasal headache

1. Obstructive infection type: middle turbinate or inferior turbinate hypertrophy, most patients can see nasal polyps or nasal septum deflection in the nasal cavity, X-ray and CT show excessive gasification of uncinate process and ethmoid vesicles, inflammation of one or more sinuses, headache Symptoms can be alleviated after anti-infection and intranasal infusion with 1% ephedrine.

2. Compression type: deviated nasal septum, hypertrophy of middle turbinate, bone spine of nasal septum and ethmoid vesicles. X-ray and CT examination showed sinus inflammation. During the onset of the headache, the affected side can be relieved by applying 1% dicaine cotton pad in the nasal cavity before and after the ethmoid nerve distribution area.

3. Mixed type: It has the etiology and clinical manifestations and characteristics of obstructive infection type and oppression type.

Rhinogenic headache treatment

Nasal headache, surgery is the first choice when clinical conservative treatment is not effective. Traditional treatment methods focus on local lesion resection, but corresponding complications often occur due to the destruction of normal anatomy, and because adjacent lesions cannot be removed, the recurrence rate is high. With the development of endoscopic technology and understanding of the anatomy and physiology of the nasal cavity and sinuses, nasal surgery has focused on maintaining its original function. The physiological abnormalities and pathological changes of the anatomical structure in and around the middle turbinate of the middle turbinate are the most critical. This area is called the sinus-oral-nasal complex (OMC). Normal OMC is a prerequisite for normal ventilation and drainage of the nasal cavity and sinuses. Therefore, the key to treating nasal headache is how to correct the abnormal anatomy. The surgical treatment of nose and sinuses at home and abroad has gradually transitioned from general surgery to functional surgery. Functional nasal and sinus endoscopic surgery (FESS) has become one of the most important methods for the treatment of nose and nose related diseases. Nasal endoscopic surgery (FESS) for the treatment of nasal headache is based on the knowledge and understanding of OMC. During the operation, the nasal septum can be corrected and centered, and the focus is on the area corresponding to the middle turbinate. Then the middle turbinate and middle nasal tract were corrected to restore and retain the morphology of the nasal septum and middle turbinate. The patency of the olfactory region and the integrity of the mucosa are retained, the OMC ventilation and drainage are improved, and the main cause of nasal headache is relieved, thereby improving the efficacy of nasal headache, reducing recurrence and reducing complications.

Nasal headache prevention

Because the causes of headaches are complex, it is recommended to encounter headaches with the following conditions, which should be considered as nasal headaches. Chronic chronic headache; Excessive vaporization of ethmoid sinus, ethmoid vesicles, middle turbinate, hypertrophy of uncinate process, etc., which may cause local compression or blockage of sinus opening; Aggravation of headache and cold; Anesthesia on mucosal surface of middle nasal passage and olfactory cleft Headaches were reduced during maxillary sinus puncture; There is no other exact cause of headache.