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By Nick Jones; Scott M Graham; et al

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21. Bendtsen L. Central sensitization in tension-type headache – possible pathophysiological mechanisms. Cephalagia 2000; 20: 486–508. 22. Jensen R, Olesen J. Tension-type headache: an update on mechanisms and treatment. Curr Opin Neurol 2000; 13: 285–9. 23. Jones NS. Midfacial segment pain: implications for rhinitis and rhinosinusitis. Clin Allergy Immunol 2007; 19: 323–33. 24. Wustrow TP, Kastenbauer E. Surgery of internal nasal valve. Facial Plast Surg 1995; 11: 213–27. 25. Ren K, Dubner R. Central nervous system plasticity and persistent pain.

They may have been treated for a long period with antibiotics and topical nasal steroids and a few patients have had some transient response on occasions that may be related to the placebo effect or cognitive dissonance, but these are inconsistent. Patients often describe tenderness on touching the areas of the forehead or cheeks, leading them to think there is underlying inflammation of the bone. However, on examination there is hyperaesthesia of the skin and soft tissues in these areas (see list above), and gently touching these is enough to cause discomfort similar to the tender areas over the forehead and scalp seen with tension-type headache.

J Orofac Pain 1999; 13: 155–63. Sessle BJ. Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and other clinical correlates. Crit Rev Oral Biol Med 2000; 11: 57–91. Lin TJ, Maccia CA, Turnier CG. Psychogenic intractable sneezing: case reports and a review of treatment options. Ann Allergy Immunol 2003; 91: 575–8. 28. Fochtmann LJ. Intractable sneezing as a conversion symptom. Psychosomatics 1995; 36: 103–12. 29. Kimmelman CP. The risk to olfaction from nasal surgery.

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