Self-reported sinus headaches are associated with neck pain and cervical musculoskeletal dysfunction: a preliminary observational case control study

J Man Manip Ther. 2019 Sep;27(4):245-252. doi: 10.1080/10669817.2019.1572987. Epub 2019 Feb 4.


Objectives: Headaches can be associated with rhinosinusitis and may present a diagnostic challenge because of symptomatic overlap with other recurring headaches. Neck pain has received extensive attention in migraine, tension-type and cervicogenic headache but not as a comorbid feature of headache in those with rhinosinusitis. This study investigated the occurrence of neck pain and cervical musculoskeletal dysfunction in individuals with self-reported sinus headaches (SRSH). Methods: Participants with and without SRSH attended a single data collection session. Participants completed the Headache Impact Test (HIT)-6 and the Sino-Nasal Outcome Test (SNOT)-22. Cervical range of motion (ROM), segmental examination, muscle endurance and pressure-pain threshold (PPT) were measured . Results: Participants included 31 with SRSH (77.4% female; age 43.7 (9.9) years) and 30 without headache. Average symptom duration was 89.7 (±85.6) months. Mean SNOT-22 and HIT-6 scores were 36.2 (15.3) and 56.7 (7.1), respectively. In the SRSH group, 83.9% (n = 26) reported neck pain. There was a significant difference between groups for cervical sagittal (14.3° [5.3°, 23.3°], p = 0.002) and transverse plane ROM (21.5° [12.4°, 30.6°], p < 0.001), but no difference in frontal plane motion (p = 0.017). There were significant between groups difference in neck flexor endurance (19.5 s [10.1 s, 28.9 s], <0.001), segmental dysfunction O-C4 (p < 0.001) but not in PPT (p = 0.04). Discussion: Neck pain and cervical musculoskeletal dysfunction are common among persons with SRSH and may be a comorbid feature or contributing factor to headaches attributed to rhinosinusitis. Further research is needed to understand these associations.

Keywords: Sinus; headache; muscle strength; neck pain; range of motion; rhinosinusitis.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Case-Control Studies
  • Cervical Vertebrae / physiopathology*
  • Comorbidity
  • Female
  • Headache / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength
  • Neck Muscles / physiopathology*
  • Neck Pain / epidemiology*
  • Neck Pain / physiopathology
  • Pain Threshold
  • Pressure
  • Range of Motion, Articular*
  • Rhinitis / epidemiology*
  • Self Report
  • Sino-Nasal Outcome Test
  • Sinusitis / epidemiology*
  • Young Adult

Grants and funding

This work was supported by the Des Moines University Iowa Osteopathic Education Research and Grants under Grant 112-3126.