Non-Rhinologic Etiologies of Headaches and Facial Pain in Tertiary Care Setting

1. Rationale Our aim is to conduct a prospective study to assess the patients referred for
rhinosinusitis to a tertiary rhinologic practice whose symptoms include headache/facial
pain, but have no evidence of significant rhinologic disease and determine whether a
neurologic etiology is responsible for headaches or facial pressure/pain symptoms.

2. Key Objectives 1. Assess prevalence of headache syndromes in patients with primary
complaints of facial pain and headaches. 2. Correlate average Lund McKay CT scan score
in patients with headache syndromes

3. Study Population Patients referred to Dr. McGinn's otorhinolaryngologic practice for
assessment of rhinosinusitis who do not meet the criteria for the diagnosis of
rhinosinusitis.

4. Major Inclusion & Exclusion Criteria Inclusion criteria include patients greater than
18 years of age, literate in the English language, referred by a physician for primary
complaint of "sinusitis", major symptomatic complaint of headache or facial
pain/pressure, CT scan must have been performed prior and available for review at the
time of visit. Exclusion criteria include evidence of chronic rhinosinusitis, a
modified LM score greater than 2, pregnancy, history of prior facial trauma or tumor in
the head and neck region, specifically the nasal area, past history of autoimmune
disorder affecting the head and neck region (e.g., Wegener's granulomatosis).

5. Allocation to Groups None

6. Procedures: Participants will be asked to complete a headache questionnaire and the
SNOT-20 questionnaire (a validated tool developed by Dr. Picirillo). Information from
the subjects' medical records related to their headaches and facial pain will be
recorded for the research. This information will include the results of the CT scan,
nasal endoscopic exam, and clinical exam.

7. Major Risks and Discomforts: Loss of confidentiality.

8. Confidentiality: No patient names or other identifying information will be revealed in
the course of the study. There will be no direct patient identifiers on the database
utilized for this study. The initial patient form scanned into the database will
utilize a coded identifier based on chronological order in order to prevent inadvertent
disclosure of private medical data. The code will be kept secure in a locked filing
cabinet in the principal investigator's office and destroyed once the data are
collected and the study is completed.

9. Investigator Qualifications & Specific Roles in the Research Johnathan M. McGinn, MD is
a board certified otolaryngologist.

10. Study Site Location(s) - Hershey Medical Center outpatient clinic

Inclusion Criteria:

- patients greater than 18 years of age

- literate in the English language

- referred by a physician for primary complaint of "sinusitis"

- major symptomatic complaint of headache or facial pain/pressure

- CT scan must have been performed prior and available for review at the time of visit

Exclusion Criteria:

- evidence of chronic rhinosinusitis

- a modified Lund Mackay score greater than 2 on CT

- pregnancy

- history of prior facial trauma or tumor in the head and neck region, specifically the
nasal area

- past history of autoimmune disorder affecting the head and neck region (e.g.,
Wegener's granulomatosis).