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SINUS
HEADACHE, OR IS IT MIGRAINE?
PHILADELPHIA—What feels like a sinus headache, has some of the symptoms of a sinus headache, and—given the self-diagnosis of many patients— “quacks” like a sinus headache?
According to a study presented at the 53rd Annual Meeting of the American Academy of Neurology, it may be a migraine. The results of the study, if borne out by a larger trial, could have important clinical implications for the treatment of migraine while guiding further research into the potential overlap of these two types of headache.
THINK IT’S SINUS?
TREAT A MIGRAINE
In the study, 29 (97%) of the 30 subjects with self-described “sinus” headache had symptoms that met International Headache Society criteria for migraine or migrainous headache. Although only about half of the subjects had consulted a physician, all reported treating their headache with different over-the-counter medications. More than half (57%) were dissatisfied with the treatment. Furthermore, 86% described their headache as having either a very severe or substantial impact on their daily functioning and/or quality of life.
This small study suggests that many people attributing their headache to sinuses could benefit from migraine treatment, said Curtis P. Schreiber, MD, of the Headache Care Center in Springfield, Missouri.
“For a lot of these patients, their so-called sinus headache does matter, because it is interfering with their daily activities and many of them are not getting effective treatment,” he said.
There are two messages in these findings, according to Dr. Schreiber: Patients with self-diagnosed “sinus” headaches who are not doing well with their treatment should see their doctor and describe all of their symptoms. For doctors, the message is to look beyond their patients’ initial self-diagnosis.
“Instead of prescribing something and finding your patients doing better after two or three days of limping along, make a more specific diagnosis to help them get through the process and back to normal functioning sooner,” Dr. Schreiber advised.
MIXED SYMPTOMS, UNCLEAR CRITERIA
It has been shown that people who suffer from migraine often have a spectrum of headaches with varying clinical manifestations, including migraine and migrainous and tension-type headaches. Many individuals with headache do not obtain a medical diagnosis, resulting in the self-described “sinus” headache that this study sought to address. But the diagnostic criteria for distinguishing between sinus and migraine headache are not clear, Dr. Schreiber observed.
“Sinus headache could be considered the poor stepchild of headache,” he said. “Practically all of the research that has gone on in headache has been focused on migraine.”
Even the diagnostic criteria established in the ear, nose, and throat (ENT) field, where a lot of patients with sinus problems wind up, are of little use to differential diagnosis of recurrent headaches. The ENT criteria, Dr. Schreiber explained, are very infection-oriented, focused on symptoms of fever, purulent discharge, and radiographic evidence of sinus abnormalities—the very symptoms that comprised the main exclusionary criteria in the headache study.
“We were looking at people who didn’t appear to be having infections at all, yet were having recurrent, episodic so-called sinus headaches,” he said. “We did not want to have people in the study who had acute sinusitis.”
Yet, when one looks at the symptoms subjects described having with their headaches, the picture is quite mixed. The number one symptom cited by subjects was moderate to severe pain (97%). Other symptoms consistent with migraine included photophobia, pain worsening with activity, and pulsating headache. The second and third most common symptoms, however, were nasal stuffiness (73%) and drainage (67%), and many patients first noticed the changes occurring in the area around their eyes—all symptoms associated with sinus headache.
“There is certainly a mix of symptoms here,” Dr. Schreiber said. “What we really want to focus on is that there’s more to it than just sinuses, that these patients have symptoms of both. And with a more accurate diagnosis, patients may find better treatments.”
NR
—Fred Balzac
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