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Face / Other

The face, nose and sinus structures are predominantly supplied with sensation from a nerve coming through the skull base called the "trigeminal nerve". It consists of three branches, upper (ophthalmic), middle (maxillary) and lower (mandibular). It is the fifth cranial nerve and these branches are known as V1, V2 and V3! Pathology involving one of these branches can cause pain in the distribution of other branches or in more remote areas according to connections of the trigeminal nerve with other nerves in the skull. This is called "referred neuralgia". An understanding of the anatomy and function of this nerve and its connections is necessary to explain and diagnose headache causing conditions in this region.

The following conditions are representative but not all inclusive.

Facial Cellulitis (skin infection)

Infections generally due to staph or strep causing inflammation, redness, swelling and pain in skin which can spread to involve adjacent areas or spreads internally to cause brain abscess, meningitis and death (severe skin infections can cause serious complications !!)

Aggressive treatment with antibiotics often by intravenous therapy and attention to the causative lesion (eg abscess or boil) and predisposing conditions (eg poorly controlled diabetes)

Tumours

Benign and malignant

Primary (arising locally) or secondary (spreading from other sites in the body)

These tumours cause pain predominantly from involvement of branches of the trigeminal nerve or involvement of blood vessels

Temporal Arteritis

Autoimmune inflammation of the artery of the "temple region". Often presents with frontal and temporal headache. Common in the elderly and can be diagnosed on basis of blood tests and artery biopsy. May involve the artery of the eye and cause blindness. Treated with steroids and immune suppression.

Trigeminal Neuralgia

A syndrome consisting of recurrent excruciating shooting or stabbing pains of brief duration involving any part of the face supplied sensation by the trigeminal nerve. Also called tic douloureux

Classification:

Idiopathic (ie, no cause found)

Central Lesions

Primary & Secondary causes

Demyelination (breakdown of the lining of nerve fibres in the brain)

Cerebrovascular Disease

Post-herpetic Neuralgia (Herpes zoster infection = "shingles")</p> <p><strong>Dental Neuralgia</strong> (toothache)</p> <p>Temporomandibular (Jaw) Joint Dysfunction (abnormal jaw joint function due to bite abnormalities, previous trauma to the jaw, arthritis of the jaw joint and muscle tension imbalance of the muscles attached to the jaw)</p> <p><strong>Migraine</strong></p> <p>A well known condition consisting of headache, nausea, vomiting, photophobia, lasting generally less than one day and often preceded by an aura (well recognised neurologic disturbance such as a visual disturbance lasting < one hour).</p> <p>A subject in itself !!</p> <p>Refer to other contributions at this site dedicated to Migraine and it's causes.</p> <p><strong>Migrainous Neuralgia</strong></p> <p>Also called cluster headaches</p> <p>Commoner in men, related to migraine</p> <p>Attacks occur in clusters lasting 1-3 months with symptom free periods in between</p> <p>Pain starting in early morning behind one eye (always the same), becoming red and teary. Builds quickly to crescendo and lasts 1-2 hours.</p> <p>Alcohol can precipitate.</p> <p>Requires specialist assessment and medications.</p> <p><strong>Tension Headache</strong></p> <p>Headache, often frontal and occipital of a mild nature caused by stress and increased muscle tension</p> <p>Treated by simple analgesics and recognition and management of underlying stress</p> <p><strong>Sluder's Neuralgia</strong> (Vidian Neuralgia)</p> <p>Intractable pain in the region of the nose, eye, cheek and lower jaw</p> <p>A controversial diagnosis, A type of trigeminal neuralgia, A type of migrainous neuralgia</p> <p><strong>Atypical Facial Pain</strong></p> <p>Pain which does not fit any typical description of pain syndromes as detailed above</p> <p>Many patients are stressed,anxious or depressed => psychologic</p> <p>Commoner in females. Managed with repeated strong reassurance</p> <p><strong>Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.</strong></p> <p>See Treatments Section (Ear,Nose,Throat)</p> <p><strong>Author:</strong></p> <address>Mr Anthony J. Guiney MBBS FRACS</address><address>Ear, Nose, Throat, Head & Neck Surgeon</address>"

Throat / Neck

Headache secondary to neck, pharynx and larynx (throat and voice box) conditions is not a common isolated presenting symptom. It is generally referred via branches of the lower cranial nerves or the cervical spinal nerves, or due to spread of pathology to head structures such as the meninges (coverings) of the brain.

The following conditions not uncommonly present with pain:

Inflammatory / Degenerative Cervical Spine Pathology

Osteoarthritis and osteoarthrosis of the cervical spine due to trauma or age as well as rarer conditions such as spinal cord tumours may cause headache. Such conditions are discussed elsewhere but need to be considered particularly if the pain/headache is deep-seated at the lower region of the skull or situated over the occipital regions or about the ear.

Infections

Tonsillitis and complications such as quinsy (peritonsillar abscess) may present with headache but mostly in association with other symptoms, notably throat pain and fever.

Neck space abscesses due to complications of tonsillitis, dental infection, foreign bodies (eg, impacted meat/poultry bones), tumours may also present with headache and high fever.

Tumours

Both benign and malignant tumours may cause headache by invading or compressing nerve and vascular (blood vessel) structures which have connections higher up.

Involvement / invasion of the brain and spinal cord may cause headache due to meningeal irritation or meningitis.

Cancer of the tonsil, tongue base, larynx and pharynx can present with isolated one-sided ear pain as the only symptom. In heavy smokers and drinkers of alcohol, this is a serious symptom and must be carefully assessed.

Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.

See Treatments Section (Ear,Nose,Throat)

Author:

Nose / Sinus

Headache secondary to nose and sinus disease is not uncommon and well known patterns of headache are recognised according to the particular area of the nose and sinuses affected as well as the underlying disease process. There are four groups of sinuses: the maxillary, frontal, ethmoidal and sphenoidal sinuses. Most headaches due to nose and sinus disease are associated with other symptoms and most are due to either viral (common colds) or bacterial infection.

It is common for there to be more than one underlying cause. Hence, there is great variation in how patients present.

The following conditions are representative of nose and sinus problems which may lead to head-pain,but not all inclusive.

Rhinosinusitus

Infective rhinosinusitus

May be acute or chronic

Causes include:

Viral (common colds, flu, herpes)

Bacterial

Fungal

Syphilis, tuberculosis, rhinoscleroma (all rare)

Complications of Sinusitus:

Orbit/Eye involvement including permanent blindness

Meningitis

Brain Abscess

Diagnosis

Is based on patients description of symptoms, examination findings including endoscopy of the nose, special Xrays (CT and MRI), blood and skin prick allergy tests, microbilogy swabs to culture infecting organisms

Treatment

Topical (sprays) and oral (tablets) nasal decongestants

Salt water irrigations (various formulae recommended)

Appropriate antibiotics

Topical and oral steroids

Appropriate surgery after failure of conservative treatment

Allergic rhinitis

A well known condition, acute, seasonal or chronic (perennial), caused by an abnormal response of the nasal lining to external substances called "allergens". Related to asthma and eczema

Severe cases may cause headache, fullness and pressure, amongst other symptoms

Treated similarly to infective rhinitis except avoidance of allergens and antihistamines useful

Non-allergic rhinitis

Similar symptoms to allergic rhinitis but no evidence of allergic cause. Generally non-specific irritants (eg, atmospheric pollution)

Similarly treated to allergic rhinitis

Inflammatory rhinosinusitus

Autoimmune Disease

Wegeners

Systemic Lupus Erythematosis

Sarcoidosis

"Midline granuloma"

Hormonal rhinitis

Pregnancy - marked nasal congestion may lead to infective sinusitus during pregnancy.

Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.

See Treatments Section (Ear,Nose,Throat)

Author:

General Nose / Sinus / Throat Problems

"Headache Secondary to Diseases of the Ear, Nose & Throat" Headache:

Introduction

In preparing notes for a lay persons web site about the ear, nose and throat causes of headache, one must appreciate that only a brief and incomplete description of the causes, clinical presentation, investigation and management of these conditions can be provided.

Further information can be obtained by searching key conditions either on the web or via libraries, textbooks, scientific journals, etc, or by seeking expert advice from suitably qualified health professionals.

On no account should any individual make any assumptions about symptoms they or others have based on the general information provided at this website. Patients with persistent symptoms should always seek appropriate advice from suitably qualified health professionals.

There is considerable overlap between the various health professionals in the management of patients presenting with headache and it is not uncommon for two or more experts to be involved in the care of some patients.

I hope those of you taking a look at this site find the following information useful, if not a little dry!! Remember that the objective of this site is to educate patients and other interested persons about the possible causes of headache. Don't expect an exhaustive account about each topic.

Pain causing headache is a common symptom for which there are many causes. From the perspective of the Ear, Nose and Throat Surgeon, such conditions are best described based on regional causes, i.e., the ear; nose and sinuses; and neck, including throat.

Headache secondary to nose and sinus disease is not uncommon and well known patterns of headache are recognised according to the particular area of the nose and sinuses affected as well as the underlying disease process. There are four groups of sinuses: the maxillary, frontal, ethmoidal and sphenoidal sinuses. Most headaches due to nose and sinus disease are associated with other symptoms and most are due to either viral (common colds) or bacterial infection. It is common for there to be more than one underlying cause. Hence, there is great variation in how patients present.

The face, nose and sinus structures are predominantly supplied with sensation from a nerve coming through the skull base called the "trigeminal nerve". It consists of three branches, upper (ophthalmic), middle (maxillary) and lower (mandibular). It is the fifth "cranial" nerve and these branches are known as V1, V2 and V3 ! Pathology involving one of these branches can cause pain in the distribution of other branches or in more remote areas according to connections of the trigeminal nerve with other nerves in the skull. This is called "referred neuralgia".

An understanding of the anatomy and function of this nerve and its connections is necessary to explain and diagnose headache causing conditions in this region.

Author:

Mr Anthony J. Guiney MBBS FRACS

Ear, Nose, Throat, Head & Neck Surgeon

Consultant Surgeon, Mercy Private Hospital and Rhinology Unit (Nose & Sinus Clinic), Royal Victorian Eye & Ear Hospital

Member Australian Society of Otolaryngology, Head and Neck Surgery

Member Australian Association of Facial Plastic Surgeons

General & Paediatric Ear, Nose & Throat Surgery

Head & Neck Surgery including Thyroid & Parotid Surgery, Reconstructive Plastic Surgery

Audiology Assessments

Medicolegal, TAC & Workcover Assessments (Registered Impairment Assessor)

Special Interests:

Nose & Sinus Surgery

Rhinoplasty & Otoplasty, Facial Skin Malignancy

Sleep Disordered Breathing (Management of Snoring & Sleep Apnoea)

Voice Disorders & Phonosurgery

Contact Details: