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IHSDiagnosisICD-10
11.5Headache attributed to rhinosinusitis [J01] G44.845  
Coded elsewhere "Sinus headaches"

Diagnostic criteria:

  1. Frontal headache accompanied by pain in one or more regions of the face, ears or teeth and fulfilling criteria C and D
  2. Clinical, nasal endoscopic, CT and/or MRI imaging and/or laboratory evidence of acute or acute-on-chronic rhinosinusitis1;2
  3. Headache and facial pain develop simultaneously with onset or acute exacerbation of rhinosinusitis
  4. Headache and/or facial pain resolve within 7 days after remission or successful treatment of acute or acute-on-chronic rhinosinusitis

Notes:

  1. Clinical evidence may include purulence in the nasal cavity, nasal obstruction, hyposmia/anosmia and/or fever.
  2. Chronic sinusitis is not validated as a cause of headache or facial pain unless relapsing into an acute stage.

Comments:

Other conditions that are often considered to induce headache are not sufficiently validated as causes of headache. These include deviation of nasal septum, hypertrophy of turbinates, atrophy of sinus membranes and mucosal contact. The last, however, is defined in the appendix under A11.5.1 Mucosal contact point headache.

Migraine and tension-type headache are often confused with 11.5 Headache attributed to rhinosinusitis because of similarity in location of the headache. A group of patients can be identified who have all of the features of 1.1 Migraine without aura and, additionally, concomitant clinical features such as facial pain, nasal congestion and headache triggered by weather changes. None of these patients have purulent nasal discharge or other features diagnostic of acute rhinosinusitis. Therefore it is necessary to differentiate 11.5 Headache attributed to rhinosinusitis from so-called "sinus headaches", a commonly-made but non-specific diagnosis. Most such cases fulfil the criteria for 1.1 Migraine without aura, with headache either accompanied by prominent autonomic symptoms in the nose or triggered by nasal changes.

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