Here’s a simple truth to take away: incidentally-noted “chronic sinusitis” on CT should not be used as a scapegoat for acute atraumatic headache symptoms in the ED.
This is a retrospective review of non-contrast head CT at a single center in Boston, comparing 234 patients undergoing CT for atraumatic headache and 266 undergoing CT for minor head injury. 22.2% of atraumatic headache patients received radiologic diagnoses of “chronic sinusitis”, while 17.7% of minor head injury patients had a similar radiologic finding. The authors conclude, within the limitations of this retrospective review, that findings of “chronic sinusitis” are purely incidental, and unlikely to be related to an Emergency Department visit for acute atraumatic headache, and should not be diagnosed with “sinus headache”.
This fits in with multiple other investigations demonstrating most “sinus headaches” outside the context of acute upper respiratory infection meet criteria for migrane, and respond to serotonin-receptor agonists. Do not treat these patients with antibiotics, and do not correlate these incidental radiologic findings with acute pathology.
“Findings of chronic sinusitis on brain computed tomography are not associated with acute headaches.”
http://www.ncbi.nlm.nih.gov/pubmed/24750900