In-Office Treatment of Pediatric Headache

Clinical History: A teenage patient was referred for evaluation of chronic headaches(> 12  weeks).  Mother states that the child’s headaches are constant in nature and focused above the eyes, mainly on the left side.  They have tried over the counter medications including headache relief and cold/sinus medicine.  At times the patient notes difficulty with pressure over the cheek areas as well, and they treated this with nasal sprays and antihistamines.  Various courses of antibiotics have been used as well – with little relief noted.  The family says the child was evaluated for migraine as well – again without relief using traditional migraine medications.  Seeking further options, the patient was referred to GNO Snoring and Sinus.

Physical Exam: Clinical and physical exam revealed a component of pressure overlying the frontal(forehead) region.  Further, the child says there is a “behind the eye” pressure sensation as well.  A nasal endoscopy was performed revealing no evidence of nasal polyps.  There was, however, some swelling in the region of normal sinus drainage – likely preventing normal drainage and causing a build-up of pressure.  An in-office CT Sinus was then performed revealing evidence of trapped sinus secretions at both the frontal (PreOp CT Scan 1) and sphenoid sinus (PreOp CT Scan 2).  This resulted in an accurate diagnosis of headache secondary to chronic frontal and sphenoid sinusitis. 

Treatment: The patient underwent in-office balloon sinuplasty of the affected sinuses for treatment.

Before:

PreOp CT Scan: (2/2016)

presphenoid   prefrontal

After:

Treatment: In Office Balloon Sinuplasty: (4/2016)
PostOp CT Scan:  (5/2016)

postsphenoid   postfrontal

Summary: Following the in-office sinus dilation, the patient noted a significant decrease in the headaches.  This is clearly evident from the complete clearance of sinus secretions noted in both PostOp CT Scans 1 & 2.

It is not uncommon for adolescents to experience headaches which are initially treated as migraine, but after failure of medical therapy it is apparent that trapped sinus secretions contribute to the increased pressure that is the true source of the headache.  These are classified as Sinus Headaches.  These patients are ideal candidates for in-office procedures as simply restoring ventilation of the impaired sinus can improve overall symptoms.

With an accurate diagnosis, proper treatment is provided resulting in improved clinical symptoms.

To learn more about in-office sinus dilation and various other office based procedures available at GNO Snoring and Sinus, please contact us to learn more.