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PART 1 (DEFINITION → CLASSIFICATION → ANATOMICAL BASIS → PATHOPHYSIOLOGY → MAJOR ENT CAUSES — NOSE & SINUSES)

1. EXAM-READY DEFINITION

  • Headache is defined as pain or discomfort localized to the head, face, or upper neck, resulting from stimulation of pain-sensitive structures, including mucosa, periosteum, muscles, blood vessels, and nerves.

  • In ENT practice, headache is a common presenting complaint and often represents referred pain from diseases of the nose, paranasal sinuses, ear, pharynx, larynx, or cervical structures.

One-Line University Answer

Headache in ENT is commonly due to referred pain from diseases of the nose, sinuses, ear, throat, and related structures.

2. IMPORTANCE OF ENT-RELATED HEADACHE (EXAM & CLINICAL SIGNIFICANCE)

  • Very frequently asked as:

    • Long question

    • Short notes

    • Viva

    • Differential diagnosis station

  • ENT causes are often missed and misdiagnosed as:

    • Migraine

    • Tension headache

  • Correct identification prevents unnecessary neurological investigations

  • Examiner focuses on:

    • Anatomical basis of referred pain

    • Sinogenic headache myths

    • Differentiation from primary headaches

Exam Line

Not all headaches are neurological; many originate from ENT pathologies.

3. CLASSIFICATION OF HEADACHE (ENT-ORIENTED)

3.1 BROAD CLASSIFICATION

Type Examples
Primary headache Migraine, tension, cluster
Secondary headache ENT causes, intracranial, vascular

ENT headaches fall under secondary headaches.

3.2 CLASSIFICATION BASED ON ENT ORIGIN

  • Nasal & sinus headache

  • Otogenic headache

  • Pharyngeal & tonsillar headache

  • Laryngeal & hypopharyngeal headache

  • Cervical & referred ENT headache

  • Neuralgic headaches related to ENT

4. ANATOMICAL BASIS OF ENT-RELATED HEADACHE (EXTREMELY IMPORTANT)

ENT headaches are mostly due to referred pain, explained by shared nerve supply.

4.1 PAIN-SENSITIVE STRUCTURES IN ENT

  • Nasal mucosa

  • Sinus mucosa

  • Periosteum

  • Muscles

  • Blood vessels

  • Cranial nerves

4.2 CRANIAL NERVES INVOLVED (EXAM FAVORITE)

Nerve ENT Area Supplied Headache Relevance
Trigeminal (V) Nose, sinuses, ear Most important
Glossopharyngeal (IX) Tonsil, pharynx Throat-related headache
Vagus (X) Larynx Referred pain
Facial (VII) Ear Otogenic pain
Upper cervical nerves Neck Occipital headache

Exam Line

Trigeminal nerve is the main nerve involved in ENT-related headache.

4.3 WHY SINUS HEADACHE IS REFERRED

  • Sinus mucosa is supplied by branches of trigeminal nerve

  • Pain perceived over:

    • Forehead

    • Face

    • Orbit

    • Teeth

5. PATHOPHYSIOLOGY OF ENT HEADACHE

5.1 MECHANISMS

  • Inflammation → release of mediators

  • Mucosal edema → pressure changes

  • Obstruction of sinus drainage

  • Muscle spasm

  • Neural irritation

5.2 KEY CONCEPT (EXAM TRAP)

  • Mucosal contact alone does NOT cause headache

  • Headache occurs only when:

    • Inflammation

    • Infection

    • Pressure changes

    • Neural involvement

Exam Line

Simple nasal septal deviation does not cause headache unless associated with sinus disease.

6. NASAL & SINUS CAUSES OF HEADACHE (MOST IMPORTANT SECTION)

6.1 ACUTE RHINOSINUSITIS

PATHOPHYSIOLOGY

  • Acute infection of sinus mucosa

  • Obstruction of ostia

  • Accumulation of secretions

  • Increased intra-sinus pressure

CHARACTERISTICS OF HEADACHE

  • Severe

  • Throbbing

  • Localized over affected sinus

  • Worse on bending forward

  • Associated with fever and nasal discharge

SITE-WISE PAIN DISTRIBUTION (VERY HIGH-YIELD)

Sinus Site of Headache
Frontal Forehead
Maxillary Cheek, upper teeth
Ethmoid Between eyes
Sphenoid Vertex, occiput

Exam Line

Headache of acute sinusitis worsens on bending forward.

6.2 CHRONIC RHINOSINUSITIS

PATHOPHYSIOLOGY

  • Chronic inflammation

  • Poor drainage

  • Low-grade infection

HEADACHE FEATURES

  • Dull, aching

  • Poorly localized

  • Heaviness rather than pain

  • Worse in morning

Exam Line

Chronic sinusitis causes dull headache rather than severe pain.

6.3 SINUS BAROTRAUMA (FLYING / DIVING HEADACHE)

MECHANISM

  • Failure of pressure equalization

  • Obstructed sinus ostium

FEATURES

  • Sudden severe pain

  • Occurs during ascent or descent

  • Common in frontal and maxillary sinuses

6.4 ALLERGIC RHINITIS-RELATED HEADACHE

MECHANISM

  • Nasal congestion

  • Venous engorgement

  • Sinus ostial blockage

FEATURES

  • Frontal heaviness

  • Seasonal

  • Associated with sneezing and itching

6.5 CONTACT POINT HEADACHE (CONTROVERSIAL, EXAM-TRICKY)

  • Caused by contact between:

    • Deviated septum

    • Turbinate

  • Headache occurs only if:

    • Mucosal inflammation present

Exam Line

Mucosal contact without inflammation does not cause headache.

6.6 NASAL POLYPS

  • Usually do NOT cause headache

  • Headache occurs only if:

    • Secondary sinusitis present

7. DIFFERENTIATING SINUS HEADACHE FROM MIGRAINE (EXAM FAVORITE)

Feature Sinus Headache Migraine
Fever Present Absent
Nasal discharge Present Absent
Photophobia Rare Common
Aura Absent Common
Worse on bending Yes No

Written And Compiled By Sir Hunain Zia (AYLOTI), World Record Holder With 154 Total A Grades, 7 Distinctions And 11 World Records For Educate A Change MBBS 4th Year (Fourth Year / Professional) Otorhinolaryngology (ENT) Free Material

8. OTIC (EAR-RELATED) CAUSES OF HEADACHE (VERY HIGH-YIELD)

Headache originating from the ear is usually due to referred pain through trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), and upper cervical nerves.

8.1 ACUTE OTITIS MEDIA

Pathophysiology

  • Acute inflammation of middle ear mucosa

  • Accumulation of purulent exudate

  • Increased middle ear pressure

  • Stretching of tympanic membrane

Headache Characteristics

  • Deep-seated temporal headache

  • Throbbing

  • Severe in children

  • Associated with:

    • Ear pain

    • Fever

    • Hearing loss

Exam Line

Acute otitis media may cause temporal headache due to increased middle ear pressure.

8.2 ACUTE MASTOIDITIS

Mechanism

  • Extension of middle ear infection

  • Inflammation of mastoid air cells

  • Periosteal irritation

Headache Features

  • Persistent post-auricular headache

  • Tenderness over mastoid

  • Worse at night

  • Associated with fever and ear discharge

Exam Line

Mastoiditis causes post-auricular headache with mastoid tenderness.

8.3 OTITIS EXTERNA

Mechanism

  • Inflammation of external auditory canal

  • Irritation of auriculotemporal nerve (V₃)

Features

  • Localized temporal headache

  • Pain increases on:

    • Tragus pressure

    • Pulling pinna

8.4 MALIGNANT OTITIS EXTERNA (IMPORTANT)

Pathophysiology

  • Invasive infection (usually Pseudomonas)

  • Skull base osteomyelitis

  • Cranial nerve involvement

Headache Features

  • Severe deep-seated headache

  • Night pain

  • Persistent, progressive

  • Seen in diabetics and immunocompromised

Exam Line

Severe persistent headache in an elderly diabetic with otorrhea suggests malignant otitis externa.

8.5 TEMPOROMANDIBULAR JOINT (TMJ) DISORDERS

Mechanism

  • TMJ inflammation or dysfunction

  • Auriculotemporal nerve involvement

Features

  • Temporal headache

  • Worse on chewing

  • Clicking of jaw

  • Ear pain without ear disease

9. PHARYNGEAL & OROPHARYNGEAL CAUSES OF HEADACHE

9.1 ACUTE TONSILLITIS

Mechanism

  • Inflammation of tonsils

  • Glossopharyngeal nerve irritation

Headache Features

  • Dull occipital or generalized headache

  • Associated with:

    • Fever

    • Sore throat

    • Dysphagia

9.2 PERITONSILLAR ABSCESS (QUINSY)

Pathophysiology

  • Collection of pus in peritonsillar space

  • Severe inflammation and muscle spasm

Headache Features

  • Severe unilateral headache

  • Radiates to ear

  • Associated with:

    • Trismus

    • Muffled voice

Exam Line

Severe unilateral headache with trismus suggests peritonsillar abscess.

9.3 RETROPHARYNGEAL ABSCESS

Mechanism

  • Deep neck infection

  • Pressure on cervical structures

Features

  • Occipital headache

  • Neck stiffness

  • Fever

  • Dysphagia

10. LARYNGEAL & HYPOPHARYNGEAL CAUSES

10.1 ACUTE LARYNGITIS

  • Usually mild headache

  • Associated with fever and malaise

  • Often part of URTI

10.2 LARYNGEAL CARCINOMA (REFERRED HEADACHE)

Mechanism

  • Glossopharyngeal and vagal nerve involvement

Features

  • Persistent headache

  • Associated with:

    • Hoarseness

    • Dysphagia

    • Referred ear pain

Exam Line

Referred otalgia with headache may indicate laryngeal carcinoma.

11. NEURALGIC HEADACHES RELATED TO ENT (VERY IMPORTANT)

11.1 TRIGEMINAL NEURALGIA

Mechanism

  • Irritation of trigeminal nerve

  • Often idiopathic or due to compression

Features

  • Sudden, severe, electric shock-like pain

  • Unilateral

  • Triggered by:

    • Touch

    • Chewing

    • Talking

11.2 GLOSSOPHARYNGEAL NEURALGIA

Mechanism

  • Irritation of glossopharyngeal nerve

Features

  • Sharp stabbing pain in:

    • Tonsil

    • Pharynx

    • Ear

  • Triggered by swallowing or talking

Exam Line

Glossopharyngeal neuralgia causes stabbing throat pain radiating to the ear.

11.3 SLUDER’S NEURALGIA (SPHENOPALATINE GANGLION NEURALGIA)

Mechanism

  • Irritation of sphenopalatine ganglion

Features

  • Deep facial headache

  • Retro-orbital pain

  • Associated nasal congestion and lacrimation

12. CERVICAL & REFERRED ENT HEADACHES

12.1 CERVICAL SPONDYLOSIS

Mechanism

  • Upper cervical nerve root irritation

  • Muscle spasm

Features

  • Occipital headache

  • Neck pain

  • Worse with neck movement

12.2 STYLOID PROCESS (EAGLE’S SYNDROME)

Mechanism

  • Elongated styloid process

  • Irritation of glossopharyngeal nerve

Features

  • Throat pain

  • Earache

  • Headache

  • Worse on swallowing

12.3 DENTAL & MAXILLOFACIAL CAUSES

  • Impacted teeth

  • Dental abscess

  • Maxillary sinus involvement

13. DIFFERENTIATION OF ENT HEADACHE FROM PRIMARY HEADACHE (EXAM TABLE)

Feature ENT Headache Migraine
Fever Common Absent
Local ENT signs Present Absent
Nasal discharge Present Absent
Response to antibiotics Yes No
Aura Absent Common

14. IMPORTANT EXAM PEARLS (MID-ANSWER GOLD)

  • Unilateral headache with nasal symptoms → think ENT

  • Headache worsening on bending forward → sinusitis

  • Referred otalgia with headache → laryngeal or pharyngeal pathology

  • Persistent headache in diabetic with ear discharge → malignant otitis externa

Written And Compiled By Sir Hunain Zia (AYLOTI), World Record Holder With 154 Total A Grades, 7 Distinctions And 11 World Records For Educate A Change MBBS 4th Year (Fourth Year / Professional) Otorhinolaryngology (ENT) Free Material

15. DIAGNOSTIC APPROACH TO ENT-RELATED HEADACHE (EXAM-STYLE, STEP-WISE)

Headache is common, but ENT headache is diagnosed by pattern recognition + targeted examination. The examiner expects a structured approach.

15.1 FIRST RULE (EXAM GOLD)

  • Always decide first:

    • Primary headache (migraine, tension, cluster)

    • Secondary headache (ENT, ocular, intracranial, systemic)

  • In ENT context, red flags include:

    • Unilateral nasal symptoms

    • Persistent otorrhea

    • Fever with facial pain

    • Neck swelling + throat pain

    • New headache in older person (especially with nasal lesion)

15.2 KEY HISTORY POINTS (ENT-FRAMED)

Ask in the following pattern:

A. CHARACTER OF HEADACHE

  • Onset: sudden / gradual

  • Duration: minutes / hours / days

  • Frequency: episodic / persistent

  • Nature: throbbing / dull / pressure / stabbing

  • Severity: mild / moderate / severe

B. SITE AND RADIATION (HUGE EXAM POINT)

  • Forehead

  • Cheek and upper teeth

  • Between eyes

  • Vertex/occiput

  • Temporal region

  • Post-auricular region

C. TRIGGERS

  • Worse on bending forward (sinusitis)

  • Worse during flying/diving (barotrauma)

  • Worse on chewing (TMJ)

  • Triggered by swallowing (glossopharyngeal neuralgia)

  • Triggered by touch (trigeminal neuralgia)

D. ASSOCIATED ENT SYMPTOMS

  • Nasal obstruction (unilateral/bilateral)

  • Rhinorrhea (watery/purulent/foul)

  • Postnasal drip

  • Epistaxis

  • Facial heaviness

  • Hyposmia/anosmia

  • Ear pain, discharge, hearing loss

  • Sore throat, dysphagia, odynophagia

  • Hoarseness

E. SYSTEMIC SYMPTOMS

  • Fever

  • Weight loss

  • Night sweats

  • Immunosuppression / diabetes

F. RED FLAGS FOR MALIGNANCY (ENT-RELATED)

  • Unilateral nasal obstruction + epistaxis + facial pain

  • Persistent headache with cranial nerve symptoms

  • Neck nodes

  • Non-healing nasal ulcer

  • Referred otalgia with normal ear exam (throat malignancy)

16. EXAMINATION (ENT SYSTEMATIC EXAM THAT EXAMINER LOVES)

16.1 GENERAL EXAMINATION

  • Temperature (infection)

  • Pallor (chronic disease)

  • Signs of dehydration

  • Diabetic status / immunocompromised look

16.2 LOCAL ENT EXAMINATION

A. NOSE

  • External inspection:

    • Swelling, deformity, tenderness

  • Anterior rhinoscopy:

    • Mucosal edema

    • Polyps

    • Pus in middle meatus

    • Deviated septum

  • Nasal endoscopy:

    • Osteomeatal complex assessment

    • Source of pus

    • Unilateral mass (papilloma/tumour)

B. PARANASAL SINUS EXAM

  • Sinus tenderness:

    • Frontal: above medial eyebrow

    • Maxillary: cheek/infraorbital

  • Transillumination (classical teaching; less reliable)

  • Facial swelling, periorbital edema

C. EAR

  • Otoscopy:

    • TM status

    • Bulging TM (AOM)

    • Retraction (Eustachian tube dysfunction)

    • Discharge (CSOM)

    • Canal edema (otitis externa)

  • Mastoid tenderness

D. THROAT

  • Tonsils:

    • Exudate, enlargement

    • Peritonsillar bulge

  • Posterior pharyngeal wall:

    • Pus streaking (sinusitis)

  • Neck examination:

    • Nodes

    • Deep neck infection signs

E. TMJ

  • Palpate during mouth opening

  • Clicks, tenderness

  • Range of movement

F. CRANIAL NERVE SCREEN (ENT-BASED)

  • Visual acuity (sphenoid sinus/orbital spread)

  • Eye movements (orbital complications)

  • Facial nerve (malignant otitis externa)

  • Palate movement, gag reflex (IX, X)

17. INVESTIGATIONS (ENT-FOCUSED, EXAM-RELEVANT)

Investigations are chosen based on suspicion.

17.1 BASIC INVESTIGATIONS

  • CBC (infection)

  • ESR/CRP (inflammation)

  • Blood sugar (diabetic, malignant otitis externa risk)

17.2 NASAL & SINUS INVESTIGATIONS

A. NASAL ENDOSCOPY (MOST IMPORTANT)

  • Confirms:

    • Pus in middle meatus

    • Polyps

    • Mass

    • Osteomeatal obstruction

B. CT SCAN PNS (INVESTIGATION OF CHOICE FOR SINUS CAUSES)

  • Shows:

    • Mucosal thickening

    • Air-fluid levels (acute sinusitis)

    • Opacification

    • Osteomeatal complex blockage

    • Complications (orbital/intracranial)

    • Tumour vs inflammatory disease

Exam Line

CT PNS is the investigation of choice for chronic sinusitis and complication assessment.

C. MRI (WHEN NEEDED)

  • Suspected:

    • Intracranial extension

    • Orbital spread

    • Fungal invasive disease

    • Neoplasm

17.3 EAR INVESTIGATIONS

  • Pure tone audiometry (chronic ear disease)

  • Culture of discharge (CSOM, malignant otitis externa)

  • CT temporal bone (mastoiditis, complications)

17.4 THROAT / NECK INVESTIGATIONS

  • Throat swab culture (selective)

  • Ultrasound neck (nodes)

  • FNAC of nodes (malignancy suspicion)

  • CT neck (deep neck infection, tumour extent)

  • Flexible laryngoscopy (hoarseness + referred otalgia + headache)

17.5 WHEN TO THINK “NOT ENT” (IMPORTANT SAFETY IN EXAMS)

ENT evaluation is not enough if:

  • Sudden “worst headache of life”

  • Neurological deficit

  • Papilledema

  • Seizures

  • Altered consciousness
    Then:

  • urgent neuro workup is required

18. MANAGEMENT OF ENT-RELATED HEADACHE (CAUSE-BASED, EXAM-DOMINANT)

The examiner expects: “Treat the cause, not the symptom.”

18.1 GENERAL MEASURES

  • Analgesics:

    • Paracetamol, NSAIDs (if not contraindicated)

  • Hydration

  • Rest

  • Treat fever if present

  • Avoid unnecessary antibiotics unless bacterial features

18.2 MANAGEMENT BY MAJOR ENT CAUSE

A. ACUTE BACTERIAL RHINOSINUSITIS

Clinical clues

  • Fever, facial pain, purulent discharge, tenderness, worse on bending forward

Management

  • Decongestants (short course)

  • Saline irrigation

  • Analgesics

  • Antibiotics when bacterial pattern present

  • If complication suspected:

    • CT scan

    • Hospital admission

    • IV antibiotics

    • ENT surgical drainage if needed

B. CHRONIC RHINOSINUSITIS

Management

  • Saline irrigation

  • Intranasal steroids

  • Treat allergic component

  • Antibiotics only if infection flare

  • CT PNS if persistent

  • FESS (Functional endoscopic sinus surgery) if medical failure

C. ALLERGIC RHINITIS

Management

  • Allergen avoidance

  • Intranasal steroids

  • Antihistamines

  • Treat associated sinus blockage if present

D. SINUS BAROTRAUMA

Management

  • Decongestants prior to flying/diving

  • Avoid diving/flying during URTI

  • Treat underlying sinusitis or obstruction

E. OTITIS MEDIA / MASTOIDITIS

AOM

  • Analgesics

  • Antibiotics when indicated

  • Myringotomy if severe pressure and complications

Mastoiditis

  • Urgent ENT management

  • IV antibiotics

  • Mastoidectomy if needed

F. OTITIS EXTERNA

Management

  • Aural toilet

  • Topical antibiotic drops

  • Keep ear dry

Malignant otitis externa

  • Emergency (especially diabetic)

  • IV antipseudomonal therapy

  • Glycemic control

  • Imaging for skull base osteomyelitis

G. TMJ DISORDERS

Management

  • Soft diet

  • NSAIDs

  • Jaw rest

  • Dental referral if needed

H. THROAT INFECTIONS

  • Acute tonsillitis:

    • Analgesics, hydration

    • Antibiotics if bacterial

  • Peritonsillar abscess:

    • Drainage (needle aspiration/incision)

    • Antibiotics

    • Supportive care

I. NEURALGIAS

  • Trigeminal neuralgia:

    • Medical therapy

    • Neurology referral

  • Glossopharyngeal neuralgia:

    • Similar approach

    • ENT evaluation to exclude tumour

J. TUMOURS CAUSING HEADACHE

Approach

  • Early suspicion

  • Endoscopy + imaging

  • Biopsy confirmation

  • Multidisciplinary management

Written And Compiled By Sir Hunain Zia (AYLOTI), World Record Holder With 154 Total A Grades, 7 Distinctions And 11 World Records For Educate A Change MBBS 4th Year (Fourth Year / Professional) Otorhinolaryngology (ENT) Free Material

19. OSCE STATIONS (COMPLETE READY-TO-ANSWER)

19.1 STATION: SINUSITIS HEADACHE

Prompt

  • Patient with frontal headache worse on bending forward, fever, nasal discharge

Answer

  • Acute bacterial frontal sinusitis

  • Explain mechanism: ostial blockage → pressure

  • Plan: nasal exam, endoscopy, treat infection, CT if complications

19.2 STATION: MALIGNANT OTITIS EXTERNA

Prompt

  • Elderly diabetic with severe deep headache and ear discharge

Answer

  • Suspect malignant otitis externa

  • Explain risk: skull base osteomyelitis

  • Plan: urgent ENT, culture, CT/MRI, IV antibiotics

19.3 STATION: TMJ HEADACHE

Prompt

  • Temporal headache worse on chewing, ear exam normal

Answer

  • TMJ disorder

  • Examine TMJ, refer dental, conservative care

19.4 STATION: REFERRED OTALGIA + HEADACHE

Prompt

  • Ear pain + headache but otoscopy normal, hoarseness present

Answer

  • Suspect laryngeal/hypopharyngeal lesion

  • Do flexible laryngoscopy, imaging if needed

20. LONG & SHORT CASE SCENARIOS (UNIVERSITY STYLE)

20.1 LONG CASE 1 — SINUS HEADACHE

  • History:

    • Facial pain, purulent discharge, worse on bending forward

  • Exam:

    • Tenderness, pus in middle meatus

  • Investigation:

    • CT PNS if persistent or recurrent

  • Diagnosis:

    • Acute bacterial sinusitis / chronic sinusitis flare

  • Management:

    • Medical → FESS if refractory

20.2 LONG CASE 2 — DIABETIC WITH EAR DISCHARGE + HEADACHE

  • Suspect malignant otitis externa

  • Explain why:

    • diabetic + severe deep pain + persistent discharge

  • Plan:

    • culture, imaging, IV antibiotics, glycemic control

20.3 SHORT NOTES

  • Sinus headache vs migraine

  • Barotrauma headache

  • Glossopharyngeal neuralgia

  • Malignant otitis externa and headache

21. VIVA QUESTIONS (HIGH-FREQUENCY)

  • List ENT causes of headache

  • Explain referred pain in sinusitis

  • Which nerve supplies the sinuses?

  • Why does sinus headache worsen on bending forward?

  • What is the most dangerous ear-related cause of headache in diabetics?

  • Difference between sinus headache and migraine

  • When do you order CT PNS?

  • What features suggest an ENT malignancy in headache patient?

22. MCQs (EXAM-ORIENTED)

1. Headache that worsens on bending forward is most suggestive of:
A. Migraine
B. Acute sinusitis
C. Tension headache
D. Cluster headache
Correct Answer: B

2. Most important nerve involved in ENT-related referred headache:
A. Facial nerve
B. Vagus nerve
C. Trigeminal nerve
D. Hypoglossal nerve
Correct Answer: C

3. Severe persistent headache in an elderly diabetic with otorrhea suggests:
A. Otitis media
B. Otosclerosis
C. Malignant otitis externa
D. Eustachian tube dysfunction
Correct Answer: C

23. EXAMINER TRAPS (VERY IMPORTANT)

  • Calling every facial headache “sinus headache” without evidence

  • Not doing nasal endoscopy and relying on symptoms only

  • Ignoring referred otalgia with normal ear exam (may be tumour)

  • Missing malignant otitis externa in diabetics

  • Forgetting sphenoid sinus headache may present as vertex/occipital pain

  • Treating suspected bacterial sinusitis with antibiotics without signs of bacterial pattern

24. CLINICAL PEARLS (EXAM GOLD)

  • Unilateral nasal obstruction + headache + epistaxis = think tumour until proven otherwise

  • Sinus headache is usually accompanied by nasal symptoms and tenderness

  • CT PNS is the best imaging for sinus-based headache assessment

  • Malignant otitis externa is a dangerous ENT cause of headache in diabetics

  • Referred otalgia with headache can be a sign of throat or laryngeal malignancy

  • Sphenoid sinus disease can present with deep central headache without nasal discharge

Written And Compiled By Sir Hunain Zia (AYLOTI), World Record Holder With 154 Total A Grades, 7 Distinctions And 11 World Records For Educate A Change MBBS 4th Year (Fourth Year / Professional) Otorhinolaryngology (ENT) Free Material

Hunain Zia

Hunain Zia has previously achieved considerable success in the high-school educational stream, gaining a massive 154 Total A Grades and 7 Major Distinctions, a process in which he broke/ set 11 different world records, including the most A grades ever achieved, most subjects ever appeared in, most distinctions, gaining distinctions across two separate boards (Pearson Edexcel and CAIE) within the same year/ ever, and even 19 hours of constant examination. All records stand intact today. Hunain pursued his Honors Accounting Degree from the prestigious Bentley University, and then completed an LLB (in Honors) from University of London. Currently, he manages multiple social and commercial projects, has founded digital streams and works tirelessly in the education sector.

Educate A Change focuses on truly bringing change in the educational sector worldwide. All our courses are designed to ensure success, and provide complete preparation without requiring any other external material. Therefore, it takes away the expense of academies, books, past paper compilations and other miscellaneous items. Instead, by just the courses we offer, the student can prepare fully for the best grades in their CAIEs, Edexcel and other high-school exams. The earnings from our course-sales are invested in social projects and growing the free educational activities of Educate A Change.