title: Clinical and 22-item Sino-Nasal Outcome Test symptom patterns in primary headache disorder patients presenting to otolaryngologists with "sinus" headaches, pain or pressure.
abstract: BACKGROUND
  The objective of this work was to study patient and 22-item Sino-Nasal Outcome Test (SNOT-22) characteristics in primary headache disorders (PHDs).
  
  
  METHODS
  Retrospective chart review of "sinus" headache/pressure/pain patients was conducted. Patients that had rhinosinusitis excluded (negative endoscopy/computed tomography [CT]), and neurologist-confirmed PHD were studied. Patterns in symptom and SNOT-22 items were analyzed by network visualization and cluster analysis.
  
  
  RESULTS
  Forty-six patients met study criteria. Forty-three (93.5%) reported "need to blow nose" and 40 (86.9%) reported postnasal drainage. Sneezing was reported by 37 (80.4%) patients, "blockage/congestion of nose" by 33 (71.8%), and "runny nose by 32 (69.6%) patients. The median SNOT-22 score was 54 (interquartile range [IQR], 40 to 63). Past history included neurological diagnoses (60%), rhinologic disease (39%; chronic rhinosinusitis [CRS], rhinitis, recurrent acute sinusitis), asthma (28%), and allergen-sensitivity (26%). Previous sinonasal surgery had been performed in 41%. Network layout and cluster analysis identified 2 patient clusters and 2 symptom clusters. Two-thirds (31) of patients formed a tight cluster (cluster 1) linking to a symptom cluster of psychosocial items wrapped tightly with "facial pain/pressure." The remaining one-third of patients (cluster 2) linked to rhinologic symptoms loosely grouped away from "facial pressure/pain." In contrast to patients in cluster 2, patients in cluster 1 were predominantly female (p < 0.04), had significantly higher (p < 0.0001) median SNOT-22 scores (60 vs 34; IQR, 53 to 67 vs 17 to 42), were more likely to have migraine history (p = 0.058), and reported being "sad" (p < 0.0001) or "embarrassed" (p < 0.006).
  
  
  CONCLUSIONS
  Prominent rhinologic symptoms can be present in PHD patients in the absence of rhinosinusitis. In particular, high symptom-burden/SNOT-22 scores and high psychosocial symptoms should raise suspicion of PHD when endoscopy and/or CT results do not correlate with symptoms.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ.
authors.forename: Devyani
authors.initials: D
authors.lastname: Lal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ.
authors.forename: Alexis B
authors.initials: AB
authors.lastname: Rounds
authors.affiliation: Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Phoenix, AZ.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Rank
authors.affiliation: Division of Allergic Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Rohit
authors.initials: R
authors.lastname: Divekar
mesh_terms: D001249:Asthma / Q000175:diagnosis*; D005260:Female; D051270:Headache Disorders, Primary / Q000175:diagnosis*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis*; D012852:Sinusitis / Q000175:diagnosis*; D011795:Surveys and Questionnaires
keywords: SNOT-22 questionnaire; chronic sinusitis; facial pain; network analysis; primary headache disorders; sinus headache; sinusitis