Headaches of Nasal Origin

Any patient suffering from a headache sufficiently severe to cause our advice to be sought should be thoroughly examined. Such a case will amply repay careful investigation. Simply to order a sedative is not a credit to the highest conception of modern medicine. In most cases, gastro-intestinal or gynaecological disorders, errors of refraction and septic foci, especially teeth, will not be overlooked, but comparatively seldom is the condition of the nose given the consideration it deserves. In this paper I propose to deal with the main types of headache which have nasal disease as a causative factor. As nasal and para-nasal defects are very common, so also are nasal and sinus headaches much more common than generally realised. Especially is this so in damp climates. In climates such as ours, attacks of "cold in the head" are prevalent. This results in a hypertrophied condition of the soft parts in the nose and occasional bony changes. This hyperplasia, together with the narrowing of the ostia of the air sinuses, or pressure on the adjacent nervous structure, is the underlying factor in nasal headaches. Regarding climatic influence, I have noticed the incidence of nasal sinus trouble and headaches of nasal origin is higher in Ireland than in the drier areas of London and South of England. Sinus disease is the most usual and most important cause of these headaches. It should be noted that the amount of discharge from a sinus, or the absence of visible discharge, is no indication of the severity of the infection. I propose to take each sinus in turn and describe the type of headache which most commonly occurs in each case. DISEASE OF THE MAXILLARY ANTRUM.-The pain is less typical than of any of the other sinus infections. Owing to the position of the ostium, the antrum does not drain satisfactorily, and the headache is therefore of a toxic nature. In acute empyema there is pain over the antrum, which may radiate to the teeth, to the side of the head, or to the eve. It is often neuralgic in character, and is usually intermittent whenever there is any discharge.