Clinical and 22-item Sino-Nasal Outcome Test symptom patterns in primary headache disorder patients presenting to otolaryngologists with "sinus" headaches, pain or pressure

Int Forum Allergy Rhinol. 2015 May;5(5):408-16. doi: 10.1002/alr.21502. Epub 2015 Mar 6.


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).

Conclusion: 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.

Keywords: SNOT-22 questionnaire; chronic sinusitis; facial pain; network analysis; primary headache disorders; sinus headache; sinusitis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Asthma / diagnosis*
  • Female
  • Headache Disorders, Primary / diagnosis*
  • Humans
  • Male
  • Retrospective Studies
  • Rhinitis / diagnosis*
  • Sinusitis / diagnosis*
  • Surveys and Questionnaires