Nasal headache
Introduction
Introduction to nasal headache Rhinogenous headache: refers to the headache caused by nasal and sinus lesions. Acute inflammation of the sinus is the most common, accounting for about 5% of all headaches. Others such as acute and chronic rhinitis, chronic sinusitis, atrophic rhinitis, and nasal septum deviation can be caused. Nasal headaches generally have symptoms of nasal diseases, such as nasal congestion, purulent sputum, etc., mostly deep headaches, dull or dull pain, no pulsation, heavy during the day, relieved during bed rest, headache has a certain part and Time, when the bow is bent down, the collar is too tight, and the whole body is used to make the venous pressure increase, the nasal mucosa is congested, and the headache is aggravated. After nasal mucosal contraction or topical anesthesia, headache can be alleviated. Nasal headache, clinically in the case of conservative treatment, surgery is preferred. Traditional treatments focus on local lesion resection, but often have complications due to disruption of normal anatomy, and the recurrence rate is high due to the failure to remove adjacent lesions. basic knowledge Sickness ratio: 0.05%-0.1% Susceptible people: no specific people Mode of infection: non-infectious Complications: brain abscess, purulent meningitis
Cause
Cause of nasal headache
Headache is a subjective symptom that is common in clinical practice, has many causes, and is very complicated. Local lesions and structural changes in the nasal cavity and sinus are closely related to the occurrence of headache. Among them, headache caused by rhinitis, sinusitis and nasal septum deviation is more common. The pathogenic factors of nasal headache are roughly divided into two categories. First, the nasal cavity is rich in sensory nerve fibers. The sensory nerves of the nasal cavity are derived from the ocular branches and maxillary branches of the trigeminal nerve. The ocular branch divides the anterior ethmoid to the anterior part of the nasal cavity. The maxillary branch divides the lateral branch of the superior and inferior nerve to the middle and lower turbinate, and the anterior, middle and posterior branches of the upper alveolar to the maxillary sinus. feel. At the same time, there is sympathetic and parasympathetic distribution in the nasal cavity, and the vasomotor 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 and narrow lumens, holes and gaps. The anatomical structure is complex and fine. Once the inflammation is invaded and the nasal anatomy is swollen and mutated, it is easy to cause nasal and sinus drainage obstacles and swelling. Pressure causes adjacent structures to be affected. Early manifestations of obstructive headache, due to long-term obstruction of the sinus ostium, the air in the sinus cavity is gradually absorbed, the so-called "vacuum headache", the mucosal vasodilation under vacuum, a large amount of serum leakage, or sinus due to inflammation exudation The pressure in the cavity is increased and a "tension headache" occurs. High nasal septum deviation and uncinate process, sputum and turbinate volume enlargement, because the nasal cavity, especially the olfactory slit, is narrowed, the middle and lower turbinate are compressed, so that the relaxation and contraction function is limited and reflex headache occurs. Inflammation irritating the nasal nerves is also one of the factors that cause headaches.
Prevention
Nasal headache prevention
Due to the complexity of the headache, it is recommended to have a headache with the following conditions, which should be considered as a nasal headache. 1 long-term chronic headache. 2 There are ethmoid sinus, sinus, excessive gasification of the middle turbinate, occipital hypertrophy, etc., which may cause local compression or blockage of the sinus. 3 headaches when the cold is aggravated. 4 In the middle nasal passage and the olfactory fissure area, the surface anesthesia or the maxillary sinus puncture headache is relieved. 5 There are no other headaches that can be explained by the exact cause.
Complication
Nasal headache complications Complications, brain abscess, purulent meningitis
Purulent meningitis, brain abscess, cavernous sinus thrombophlebitis.
Symptom
Nasal headache symptoms common symptoms runny nose and stuffy nose
1, generally have symptoms of nasal diseases, such as nasal congestion, runny nose and so on.
2, the pain is generally dull pain, dull pain, no pulsation, heavier during the day, headaches after rest, after the event is aggravated.
3, the pain has a certain part and time.
4. After taking measures such as rest, nasal drops, vapor inhalation or nasal ventilation, the headache can be relieved or temporarily relieved. When coughing, bowing, bending, and exerting force, the venous pressure of the head is increased, and the headache is aggravated.
Examine
Nasal headache examination
Film degree exam
CT examination of the nose and sinus is an important method to determine whether the nose and sinus lesions are or not.
Auxiliary inspection
1, nasal examination: anterior nasal examination, may see chronic congestion of the nasal mucosa, swelling or hypertrophy, middle turbinate hypertrophy or polypoid changes, narrowing of the middle nasal passages, mucosal edema or polyps, etc., the nose of the anterior group of sinusitis The road has pus; the pus of maxillary sinusitis is generally in the lower part 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. During the frontal sinusitis, the pus flows from the anterior segment of the middle nasal passage. In the anterior group of ethmoid sinusitis, there is a thick pus in the middle nasal passage. The posterior group of sinusitis pus flows down from the olfactory cleft, and accumulates in the posterior segment of the nasal cavity or into the nasopharynx. A posterior nasal examination should be performed if necessary to help observe whether the upper nasal passage is pus. If suspected ethmoid sinusitis and no pus in the nasal passages, 1% ephedrine can be used to contract the nasal mucosa for postural drainage to aid diagnosis. The use of fiberoptic nasopharyngoscopy or nasal-sinus endoscopy to observe the mucosal changes in the nasal wall and sinus opening and the secretion of the sinus mouth is more helpful for diagnosis.
2, oral and pharyngeal examination: in the case of odontogenic maxillary sinusitis, the second canine or the first and second molars on the ipsilateral maxillary may detect lesions. In the posterior group, sinusitis is sometimes seen with purulent secretions or dryness on the posterior pharyngeal wall.
3, X-ray sinus film and fault film: one of the important methods for the diagnosis of sinusitis, but should be combined with clinical symptoms to help diagnose. In the case of sinusitis, the sinus mucosa has different degrees of thickening, so the X-ray film can still show the size and shape of the sinus cavity, and it is more valuable for patients who need surgery. If necessary, the maxillary sinus iodine angiography can be used to confirm the diagnosis.
4, sinus puncture irrigation or catheter irrigation: maxillary sinus, frontal sinus and sphenoid sinus can be placed through the sinus ostium into the catheter for irrigation and perfusion of drugs, only because of the complex anatomical relationship, the operating technology is difficult, often difficult to succeed. The sinus puncture washing method is most commonly used for the maxillary sinus, and the puncture of other sinuses is rarely used because of the high risk. Through the puncture irrigation of the maxillary sinus, you can understand the nature of the sinus pus, how much, whether there is malodor, and can be used for bacterial culture and drug sensitivity test. It is estimated that the degree of sinus lesions and the treatment plan.
5, CT scan: When examining sinusitis, it is more clear to see whether the sinus wall is damaged or not.
6, sinus ultrasound examination: is a new diagnostic technique for the maxillary sinus and frontal sinus examination. Type A ultrasound is non-invasive, simple, rapid, and repeatable. Sinus fluid, polyps or tumors can be found.
7. Maxillary sinus endoscopy: This test is the latest method for diagnosing lesions. It was applied to the clinic in the 1970s. It can take pathological biopsy in the sinus under cold light illumination, or take pictures and video to overcome the blindness of the examination. To improve the diagnostic rate.
Diagnosis
Diagnosis and identification of nasal headache
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1, obstructive infection type: middle turbinate or inferior turbinate hypertrophy, most patients can see nasal polyps or nasal septum deviation in the nasal cavity, X-ray and CT showed uncinate process and excessive gasification of the sinus, one or more sinus inflammation, headache attack Symptoms can be alleviated when anti-infective and intranasal drops are treated with 1% ephedrine.
2, compression type: nasal septum deviation, middle turbinate hypertrophy, nasal septum bone and sputum closely related. X-ray and CT examination showed sinus inflammation. When the headache is attacked, the headache can be alleviated after treatment in the nasal cavity with the 1% dicaine cotton pad applied to the anterior sieve.
3, mixed type: with obstructive infection and compression type of etiology and clinical manifestations and characteristics.
