Otolaryngic Causes of Headaches

Diagnostic Criteria

The American Academy of Otolaryngology-Head and Neck Surgery recommends that diagnostic criteria for Acute Bacterial Rhinosinusitis (ABRS) require purulent nasal drainage plus nasal obstruction or facial pain-pressure-fullness, with symptoms either persisting ≥10 days without improvement or worsening within 10 days after initial improvement (double worsening pattern) 4, 5.
The American Academy of Otolaryngology-Head and Neck Surgery states that facial pain-pressure-fullness in the absence of purulent nasal discharge is insufficient to establish a diagnosis of acute rhinosinusitis 5.

The American Academy of Otolaryngology-Head and Neck Surgery recommends amoxicillin with or without clavulanate for 7-10 days if bacterial infection is confirmed, and observation is appropriate for viral rhinosinusitis lasting <10 days 4, 3.
The American Academy of Otolaryngology-Head and Neck Surgery suggests that intranasal corticosteroids are first-line therapy for Chronic Rhinosinusitis (CRS) 6, 3.

The American Academy of Family Physicians states that diagnostic features of migraine headache include unilateral location, throbbing character, moderate-to-severe intensity, worsening with routine activity, plus nausea/vomiting or photophobia and phonophobia 7.
The American Academy of Family Physicians recommends a trial of triptans for acute episodes and prophylactic topiramate for chronic migraine 3.
The American Academy of Family Physicians suggests that diagnostic features of tension-type headache include bilateral pressing/tightening (non-pulsatile) character, mild-to-moderate intensity, bilateral location, no aggravation with routine activity, and no nausea/vomiting (anorexia possible) 7.
The American Academy of Family Physicians recommends a trial of amitriptyline for suspected tension-type headache or facial pain without clear sinusitis 3.

The American Academy of Otolaryngology-Head and Neck Surgery recommends immediate evaluation for proptosis, visual changes, abnormal extraocular movements (orbital complications), severe headache, altered mental status, neck stiffness (intracranial complications), periorbital inflammation, edema, or erythema, and high fever with severe facial pain 4, 9, 3.

The American Academy of Otolaryngology-Head and Neck Surgery advises against diagnosing rhinosinusitis based on facial pain alone without purulent nasal discharge 4, 5.
The American Academy of Otolaryngology-Head and Neck Surgery recommends against performing sinus surgery for isolated facial pain without documented inflammation and failed medical therapy 1, 2.
The American Academy of Otolaryngology-Head and Neck Surgery suggests against prescribing antibiotics for symptoms <10 days unless severe or worsening 4, 3.