Headache and Facial Pain/Pressure in the Chronic Rhinosinusitis Population: A Systematic Review and Meta‐analysis

Abstract

ObjectiveTo evaluate the severity and prevalence of headache and facial pain/pressurere in the chronic rhinosinusitis (CRS) population.Data SourcesCINAHL, PubMed, Scopus.Review MethodsThe literature was searched from inception through June 2023 for English language articles documenting “headache” or “facial pain/pressure” and “chronic rhinosinusitis.” Data collected included Lund‐MacKay computed tomography score, Lund‐Kennedy endoscopy score, sinonasal outcome test, and visual analog scale. Meta‐analyses were performed on continuous measures (mean), proportions (%), and regression.ResultsA total of 69 studies were included with 8643 CRS patients and 703 control patients. The CRS group had a mean age of 44.1 (range: 16‐82; 95% confidence interval [CI]: 40.3‐48) and 86.1% [95% CI: 76.4‐93.5] with nasal polyposis. The control group had a mean age of 39.2 (range: 17‐88; 95% CI: 28.7‐49.8). All CRS subgroups had significantly more severe headache and facial pain/pressure when compared to the control (P < .0001). Patients without polyps had significantly more severe facial pain/pressure and headache when compared to patients with polyps (P < .0001). Facial pain/pressure is a moderate problem or worse in 29.8% of polypoid patients versus 56.4% of nonpolypoid patients; Δ26.6% [95% CI: 0.7‐50; P = .045].ConclusionsAcross all outcome metrics, CRS patients experience significantly more severe headache and facial pain/pressure when compared to a control population. Nonpolypoid patients experience significantly more severe facial pain/pressure and headache when compared to polypoid patients. The majority of nonpolypoid patients experience facial pain/pressure that is moderate in severity or worse.