Rhinologist referral to a headache specialist for non-sinogenic headache: A fast track approach to an interdisciplinary collaboration

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Conference Proceeding

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Headache: The Journal of Head and Face Pain


Background: The three most commonly diagnosed headache disorders in the US are migraine, tension type headache, and sinus headache. However, sinus headache is rarely diagnosed by headache specialists. Patients are often misdiagnosed with sinus headache by the larger medical community because they present with symptoms of drainage, congestion, and facial pressure, which can also be seen in migraine. One study found that 58% to 88% of acute sinus headaches without obvious signs of infection were actually migraines. Another study found that only 5% of patients originally diagnosed with sinus headache actually had it. Erroneous diagnosis of sinus headache leads to unnecessary medication and surgical intervention for patients. Our study aims to explore the effect of an interdisciplinary collaboration for the diagnosis and treatment of cranio-facial pain between rhinology and headache subspecialties.

Methods: We conducted a single-institution, retrospective study of patients presenting with facial pain to a rhinologist with a subsequent fast-track referral to a headache specialist for non-sinogenic headache between January 1, 2016 and March 12, 2019.

Results: A total of 98 patients were included in this study. Migraine was the most common diagnosis with 38 patients diagnosed with episodic migraine and 17 patients diagnosed with chronic migraine. No patients were diagnosed with sinus headache. 89% of the patients described their headache as frontal, with accompanied photophobia in 48.9% of patients and phonophobia in 39.7% of patients. Only 6.1% of patients endorsed nasal congestion and 1% endorsed rhinorrhea. The majority (89.8%) of the patients described their pain as moderate to severe. Nasal endoscopy was normal in 92.7% of patients, edema was noted in 5.2% of patients, and mucopurulence in 2% of patients. Endoscopic edema was only noted in patients with a final diagnosis of migraine. 22 of the 98 patients underwent neuroimaging and sinus disease was only noted in one patient.

Conclusion: The majority of patients referred by a rhinologist to a headache specialist for presumed non-sinogenic headache ultimately carried the diagnosis of a primary headache disorder. There were no patients diagnosed with headache attributed to sinus disease. Although our study had a small sample size, we believe this fast-track direct referral system between subspecialties is an innovative way to approach patient care and prevent misdiagnosis and improve patient care.



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