Development of the Sinus Headache Screener (SHS) for Identification of Non-Rhinogenic Facial Pressure/Pain

Saturday, October 11, 2025

9:30 AM - 9:36 AM EDT

Location: 242

Disclosure(s):

David W. Jang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Frederick A. Godley, MD, III:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Patients presenting with sinus headaches often have non-rhinogenic facial pain/pressure (NRFP). However, these patients are frequently misdiagnosed with sinusitis, leading to inappropriate antibiotic utilization and unnecessary surgical procedures. We introduce the Sinus Headache Screener (SHS), which was developed for the purpose of differentiating NRFP from sinusitis.

Methods: A question bank consisting of 89 items was developed through a qualitative interview process of 26 patients with midfacial pain or pressure. The question bank was then administered to a larger cohort of patients and a backward variable selection logistic model was utilized to identify the items that could best differentiate CRS from NRFP. The diagnosis of chronic rhinosinusitis (CRS) or NRFP was assigned based on imaging criteria. The predictive performance of the SHS was evaluated with the area under the receiver operating characteristic curve (AUROC).

Results: Of the 251 patients enrolled, 114 had CRS, and 137 had NRFP. Mean (SD) age was 50 (16), and 69.3% (n=174) were women. Eight items pertaining to symptom chronicity, triggers (weather changes, exercise), associated symptoms (motion sickness, loss of ability to smell, twitching on face, ear pain) and nasal mucus quality were selected and assigned a score. Using a total score of equal to or greater than 1 to identify NRFP, the eight-item SHS had a sensitivity of 0.79 and specificity of 0.64, and positive/negative predictive values of 0.72/0.73. The AUROC was 0.822 (95% confidence interval 0.796, 0.902).

Conclusions: The SHS can serve as an effective screening tool for differentiating CRS from NRFP. Given the high incidence of NRFP in the general population, the SHS could significantly improve healthcare efficiency and cost.

Presenting Author(s)

David W. Jang, MD

Associate Professor
Duke University
Durham, NC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

David W. Jang, MD

Associate Professor
Duke University
Durham, NC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

HL

Hui-Jie Lee

Disclosure information not submitted.
Frederick A. Godley, III, MD

Otolaryngologist
University Otolaryngology
North Kingstown, RI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
DW

David L. Witsell, MD

Emeritus
Duke University
Chapel Hill, NC, United States

Disclosure information not submitted.
Ralph Abi Hachem, MD

MD
Duke University
Durham, NC, United States

Disclosure information not submitted.
Bradley J. Goldstein, MD, PhD

Professor
Duke University
Durham, NC, United States

Disclosure information not submitted.
Theresa M. Coles, PhD

Associate Professor
Duke University
Durham, NC, United States

Disclosure information not submitted.