Forehead pain in the morning, relieved in the afternoon

Introduction In the morning, the forehead hurts, and the Zhejiang is aggravated. It is relieved in the afternoon and disappears in the evening. This may be frontal sinusitis. Acute sinusitis remains 30 days after the onset of inflammation, known as chronic frontal sinusitis. Often under certain conditions, acute attacks are often accompanied by chronic ethmoid sinusitis. Acute frontal sinusitis is an acute inflammation caused by streptococcal, staphylococci, and pneumococcal invasion of the frontal sinus.

Cause

1. Acute frontal sinusitis is not treated or treated improperly, causing severe damage to the mucosa, loss of normal function, and becoming chronic inflammation.

2. Allergic frontal sinusitis, nasal frontal mucosal edema, and decreased cilia transport function, which hinders drainage during acute inflammation and becomes chronic inflammation.

3. The nasal septum is high, the middle turbinate is hypertrophy, the nasal polyps, and the nasal sinus complex is blocked.

4. Pneumatic injury, such as airborne downhill, swimming and diving, diving operations, can cause chronic infection of the frontal sinus.

5. Systemic factors such as reduced immune function, diabetes, malnutrition, vitamin deficiency, etc.

an examination

(A) Mucosal congestion can be seen in the anterior nasal examination, and there is purulent secretion in the upper part of the middle nasal passage. The pus of maxillary sinusitis is mostly in the lower back of the middle nasal passage. The sinusitis can be seen in the middle nasal passage and the olfactory fissure with purulent secretion, which can be identified.

(B) Before the head position test, no pus secretions were found in the nose. The 1% ephedrine can be used to shrink the middle turbinate and the middle nasal mucosa. Then, the head is in the middle position for 5 minutes. Check the nasal cavity again to see if there is any middle nasal passage. Pus appear. When accompanied by maxillary sinusitis, the maxillary sinus puncture can be performed first, the pus is removed, and then the head drainage is performed to determine the presence of frontal sinusitis.

(C) The frontal sinus X-ray film takes the nasal frontal position and lateral position, compares the bilateral frontal sinus transmittance, and judges the lesions. The asymmetrical size of the frontal frontal sinus is normal and has nothing to do with the diagnosis of frontal sinusitis. A well-developed frontal sinus can have a bone septum, which is also normal.

(D) CT scan using coronal and axial scans, can show the size and extent of the frontal sinus, the condition of the anterior and posterior bone wall and no thickening in the sinus cavity.

(5) The symptoms of frontal sinusitis headache began to be a full headache, and later gradually limited to the upper and upper forehead of the affected eyelid. Pain has obvious time regularity. It attacks every morning and gradually increases. It is the heaviest at noon. It gradually relieves in the afternoon. At night, the headache disappears and the next day repeats. There is obvious tenderness in the upper corner of the eyelid.

Differential diagnosis

First, acute maxillary sinusitis

Often for the forehead headache, sometimes released to the ankle, the patient often feels a pain in the upper teeth, especially the molars. The patient also felt pain in the lower jaw and cheeks. Headaches are often light in the morning and heavy in the afternoon.

Second, acute frontal sinusitis

Patients often have forehead pain, which has obvious periodicity. It usually starts at 2~3h after morning, reaches orgasm at noon, gradually decreases in the afternoon, and headache disappears at night; if inflammation is not controlled, headache symptoms can be repeated the next day.

Third, acute ethmoid sinusitis

Pain and swelling can occur on the sides of the ankle and the back of the nose, which can be radiated to the top of the head. Pain increases when the eye moves, and pain in the back of the eye when the eye is pressed. The anterior group of ethmoid sinusitis may have headache manifestations of acute frontal sinusitis; the posterior group of ethmoid sinusitis is often similar to the headache symptoms of acute sphenoid

Fourth, acute sphenoid sinusitis

Often a dull pain in the base of the skull or deep in the eye, can be radiated to the top of the head and behind the ear. Although the pain after the eyeball is felt, the pain is aggravated when there is no eyeball when the eyeball is pressed.

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