Headache & Facial pain : An

ENT aspect
• This is a very common problem faced by
ENT surgeon in their day to day to day
practice. The various craniofacial structures
which may be source of headache or facial
pain are interdependent functioning system.
• Pain sensation reaches brain stain mainly
via 5 cranial nerve.
• Extra frigminal pain from other oro-facio-
cranial structure travel in 7th, 9th & 10th &
upper cranial roots.
• It is not possible to discuss all the parameter
of the subject of headache & facial pain but
a diagnostic evaluation & otolaryngology
problem as actio logical factor has been
stressed.
 Headache
• The term headache , headache above the
eyebrow level
• It is usually a benign symptom but
occasionally it is a manifestations of serious
illness such as brain tumor subara-
hemorrhage, meningitis or giant cell XXX.
 Classification of Headache
• 1.Migrane - Rec. attack of headache usually uni
lateral females are more affected XXX
Migrane without oura
Migrane with aura
Retinal migrane
• 2. Tension type headache - usually suboccipital
pt. Complaints of tightness xxx or contraction.
• 3. Cluster headache & Ch xxxxx
• 4. Headache associated head trauma:
Acute post traumatic headache
Chronic post traumatic headache
• 5. Headache or facial pain associated with
disorders of facial or cranial structure
‫ ٭‬cranial level
‫ ٭‬eye level
‫ ٭‬ears
‫ ٭‬Nose & sinuses
‫ ٭‬Teeth & jaws & related structures
‫ ٭‬TM joint diseases
• 6. Headache associated vascular disorder:
Acute ischamic xxxx disorder
Intracranial hematoma
Subarachnoid hemorrhage
• 7. Headache associated with nonvascular
intracranial disorder
High CSF pressure
Low CSF pressure
Intracranial Infection xxxx &
Intra cranial neoplasm
Associated with other intracranial disorder
• 8. Headache associated with substances or their
withdrawl
• 9. Headache associated with noncephalic infection
Viral infection Bacterial infection Other
infection
• 10. Headache associated with metabolic disorder
Hypoxia Hypercapnia Mixed hypoxia &
hypercapnia Hypoglycemia Dialysis Other
metabolic abnormality
• 11.Cranial neuralgias, nerve trunk pain
Trigeminal (tic doulourex)
Glossopharyngeal
Central
• 12. Headache no classifiable
 Evaluation of Headache
• A complete medical history recorded ia essentail
– Age & Sex
– Onset, duration, intensity, quality & frequency of
headache.
– Time relation in headache
– Location of headache
– H/o any head trauma/hypertension/allergy/use of
drug
• Aggravating and relieving factors
• Associated symptoms
• Following history
• emotional disturbances
• sociological factor
• complete ENT examination : PNS, throat
• complete neurosurgical examination
• CVS examination
• Head & neck examination
• ocular & dental
• Assessment of personality profile
radiological assessment
 ENT Causes of Headache
• Acute & chronic sinusitis - may be absent
- may be present
• Frontal sinus - Pain in frontal regions
• Maxillary sinus - Pain & tenderness on related to
maxilla.
• Sinus