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Literature highlights
Sinus headache or migraine?
The purpose of this study was to classify – according to the diagnostic criteria of the International Classification of Headache Disorders, 2nd Edition (ICHD-II) – headache types reported by patients with self-diagnosed sinus headache, so as to define an accurate clinical picture that can help establish a correct diagnosis in these patients. The American Migraine Study II study estimates that about 28 million Americans suffer from migraine. The majority of these patients remain undiagnosed and in some cases their headache is wrongly attributed to inflammation of the paranasal sinuses. However, "sinus headache" is still a poorly defined entity, with very little supporting evidence in the literature to date. The authors advertised the descriptive study "The Sinus, Allergy and Migraine Study" in the local media of the greater Phoenix, U.S., metropolitan area in order to recruit 100 subjects willing to participate in the study. All patients who believed that they suffered from sinus headache and were aged over 18 were enrolled. A detailed history and complete physical examination were performed in each patient. Based on the current diagnostic criteria of the International Classification of Headache Disorders, 2nd Edition, the patients were given the following diagnoses: migraine with or without aura in 52% of cases; chronic migraine associated with medication overuse versus probable medication overuse headache in 11%; probable migraine in 23%; cluster headache in 1%; hemicrania continua in 1%; headache secondary to rhinosinusitis in 3%; and headaches nonclassifiable in 9%. Weather changes (83%), seasonal variations (73%), exposure to allergens (62%), and changes in altitude were the most frequently reported triggering factors for migraine. Seventy-six per cent of migraine patients reported pain in the distribution of the second division of the trigeminal nerve (either unilateral or bilateral), and 62% experienced bilateral forehead and maxillary pain. The most common autonomic symptoms associated with headache were nasal congestion (56%), eyelid edema (37%), rhinorrhea (25%), conjunctival injection (22%), lacrimation (19%), and ptosis (3%). The headaches nonclassifiable were characterized by a bilateral maxillary pressure of mild to moderate intensity associated with at least one cranial autonomic symptom. Features suggestive of migraine were absent in all nine nonclassifiable cases. The authors concluded that the majority of patients with self-diagnosed sinus headache have migraine or probable migraine. In patients with migraine, the most frequent reasons for misdiagnosis include headache triggers, pain location, and associated features commonly attributed to disorders of the paranasal sinuses.
This page last modified: 30/10/2007