Dr. Shapira's Chicago Headache Blog

* required |Privacy Policy

Thursday, December 18, 2014

SINUS PAIN MISDIAGNOSIS: New Research Your Sinus Headaches or Facial Pain Are Probably Not From Your Sinus

Millions of patients treated for headaches have been diagnosed with sinus headaches or facial pain.  A new article in  2014 Dec 16 reveals that the majority of patients probably are not having sinus headaches .  The official term used in the article is Rhinogenic or coming from nasal origin or non-rhinogenic or not coming from the nose.  Please see the PubMed Abstract at the end of this blog.

While this study concludes that most of these headaches are not a primary nasal problem that does not mean that the headache does not have an effect on the sinuses and the nose.

Almost 100% of all headaches are connected to Trigeminal Nerves.  The Trigeminal Nerve is often called the Dentists Nerve because the two Largest branches are the Maxillary Nerve and the Mandibular Nerve that go to the Jaw Joints (TMJ) , The Jaw Muscles, the teeth, the gums, the periodontal ligaments and the tongue.  These are the nerves your dentist anaesthisizes for dental work.  A third branch is the Opthalmic Branch.  The sinuses are innervated by fibers from the Maxillary Branch and the Opthalmic Branch of the Trigeminal Nerve.

Another branch of the Trigeminal Nerve controls the blood flow to the anterior two thirds of the meninges of the brain.  Migaines and vascular headaches are controlled by the Trigeminal Nerve.
There is also an autonomic portion of the Trigeminal Nerve that passes thru the Sphenoalatine Ganglion (SPG).  The SPG Block is known to be extremely effective in treating and eliminating not just migraines but also chronic daily headaches, sous headaches, tension headaches and other autonomic headaches.  Learn more at www.thinkbetterlife.com to www.ihateheadaches.org

The input from the Trigeminal Nerves to the brain account for over 50% of total input after a,plification in the Reticular Activating System.  Noxius input can come in from any of the branches of the Trigeminal Nerve but the biggest input is from the Maxillary and Mandibular banshees through propriocetion in the periodontal ligament s and from muscles and joints.  TMJ disorders (TMD) have long been called The Great Imposter because the can come out as so many different types of pain.  Sinus Pain and Sinus Headaches are frequently related to myofascial pain or TMJoint pain.

This new study confirms this frequent misdiagnosis.  Patients who have been diagnosed with sinus headaches should consider being evaluated for a TMJ disorder by a Neuromuscular Dentist.  The most frequent cause of sinus pain is actually referred pain usually from Trigeminally innervated structures.  The lining of the sinus is also innervated by the Trigeminal Nerve leading to the confusion on the source of pain. 

Please read these articles for more information.

TMJ Alias, The Great Imposter, Has a Co-Conspirator: Poor Sleep ......Is Dr Shapira's guest editorial in Cranio Journal

Sat, 02/02/2013 - 09:36 — ilshapira  can be found at http://www.sleepandhealth.com/node/613



 2014 Dec 16. [Epub ahead of print]

Rhinogenic and nonrhinogenic headaches.



To review the present knowledge and the recent publications on the cause, characteristics, course and treatment of chronic and recurring facial pain and headaches. Facial pain is amongst the commonest complaints in ear, nose and throat clinics. Recent articles have presented important evidence-based approach to this common problem.


Recent publications in the fields of otolaryngology and neurology have better defined the differences between rhinogenic and nonrhinogenic facial pain, and place this symptom in the context of rhinosinusitis. Although chronic facial pain has conventionally been considered to be due to sinusitis because of anatomical proximity, there is increasing evidence to support the contrary. Published literature has identified that only 16-20% of patients with sinusitis (purulent or with polyposis) confirmed by nasal endoscopy actually declared symptoms of facial pain. More pertinently, surgical series have shown that up to 40% of patients had persistent postoperative facial pain despite resolution of sinusitis on nasal endoscopy and computed tomography (CT). Rhinogenic pain is generally unilateral, severe, located on the same side and related to rhinogenic symptoms, and almost always accompanied by endoscopic and CT abnormalities. Incidental CT mucosal disease can be noted in 30% of asymptomatic patients.


Traditionally, facial pain has often been considered to be caused by chronic rhinosinusitis. Increasing evidence has shown that the commonest cause for chronic facial pain is of nonrhinogenic origin. As otorhinolaryngologists, we deal with facial pain on a daily basis and therefore need to be aware of the different causes for this common symptom.

The following Clinical trial has been discontinued prior to enrollment.
Rhinogenic Headache Improvement After Nasal Operation (RHINO)
This study has been withdrawn prior to enrollment.
(slow accrual)
Information provided by:
University of Missouri-Columbia
ClinicalTrials.gov Identifier:
First received: December 12, 2007
Last updated: February 24, 2011
Last verified: February 2011
Objective: To determine the efficacy of surgical correction of intranasal mucosal contact points in improving quality of life and decreasing medication use in patients with rhinogenic headaches.
Significance: Chronic, debilitating headaches that resist maximal medical treatment by various headache specialists are sometimes linked to structural anomalies within the nose that exert pressure on apposing mucosal surfaces. A number of otolaryngologists have reported success in alleviating rhinogenic headaches with contact point correction surgery. This practice is supported by anecdotal reports along with retrospective and observational studies; however, a prospective study with an appropriate surgical control group has not been conducted. Because the specific effect of contact point correction has not yet been differentiated from the placebo effect of surgery itself, many headache specialists are reluctant to recommend surgical evaluation for their patients. To demonstrate the efficacy of contact point correction surgery to both the headache and otolaryngology communities - and thus, to make this treatment option more widely available to rhinogenic headache sufferers - a randomized controlled trial is needed.

Labels: , , , , , , , ,

posted by Dr Shapira at 10:57 AM

Welcome to the iHATEheadaches website, please upgrade your Flash Plugin and enable JavaScript.