Right Frontal Headaches and Nasal Congestion

Courtesy of:
Michael J. Sillers, M.D., F.A.C.S.
Alabama Nasal & Sinus Center; American Rhinologic Society

Board of Directors since 1999

Case Study:
26 year old male presented with a prolonged history of right frontal headaches and nasal congestion.


Notes:
- 26 yom presented with a prolonged h/o right frontal headaches and nasal congestion. His sense of smell was intact and he denied purulent nasal drainage.
-Diagnostic nasal endoscopy did not reveal significant inflammatory changes.
He was initially treated with topical steroids with no improvement.
-Because of localized headaches and failure to improve with initial medical therapy, a 20-second screening CT was performed with near-complete right frontal sinus opacification noted.
-The patient was treated with 2-3 week courses of antibiotics, mucolytics and topical steroids with no change in symptoms.
-Subsequent 40-second, navigation protocol CT confirmed persistent disease, similar to the initial screening CT. Options were discussed with the patient and surgery was scheduled.

Careful inspection of the CT scan shows a partially opacified right frontal sinus with a well-aerated, moderate-sized agger nasi cell. The uncinate process is thickened and the maxillary infundibulum appears obstructed with associated maxillary mucosal thickening. The anterior ethmoid artery can be seen within the anterior ethmoid sinus and the posterior ethmoid cavity is non-diseased. The patient's left side appears normal.


Conclusion:

This case illustrates a common clinical problem: headache as a primary complaint with minimal associated nasal/sinus symptoms or endoscopic findings.

CT scanning is generally not indicated as an initial test in all patients with headaches, particularly if diffuse, and prior to medical therapy. However, in patients with localized headaches, CT scanning can provide useful information and assist in guiding appropriate care.

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