9 in 10 Sinus Headaches Really Migraines

Untreated Migraine Cause of Most 'Sinus Headaches'

From the WebMD Archives

June 10, 2004 -- Got a bad sinus headache? Odds are, it's really a migraine.

If your head hurts, does it really matter what you call it? Yes, says headache specialist Eric Eross, DO, associate consultant in neurology at the Mayo Clinic in Scottsdale, Ariz.

People spend lots of money on over-the-counter "sinus headache" remedies. But they get little relief, Eross says, until they get proper treatment for migraine.

"The vast majority of people with self-diagnosed sinus headache have migraine," Eross tells WebMD. "These individuals often have a delay in getting a correct diagnosis. On average, they waited 25 years. These are headaches affecting people in the prime of their lives. The vast majority had severe disability."

Eross and colleagues advertised a free evaluation to people suffering from "sinus headaches." They signed up the first 100 people, and gave them a rigorous 1.5-hour evaluation. It turned out 90 of the 100 patients were really suffering from migraines.

Eross presented the findings at this week's meeting of the American Headache Society in Vancouver, British Columbia, Canada.

What Is a Sinus Headache?

If you have an active sinus infection, your head hurts. Typical symptoms include fever, swollen lymph nodes, and a green or yellow nasal discharge. But most people who think they have sinus headaches don't have these symptoms -- just pain high in their cheeks. They likely have migraines, Eross says.

What do sinus doctors think? It is a controversial issue, says Bradley Marple, MD, chair of the rhinology and paranasal sinus committee of the American Academy of Otolaryngology -- Head and Neck Surgery (AAO-HNS), and vice chair of the department of otolaryngology at the University of Texas Southwest Medical Center in Dallas.

"This is a really difficult and controversial area right now. It hasn't completely been resolved," Marple tells WebMD. "There are headaches caused by sino-nasal disease. There is also a whole host of other types of headaches. It is difficult to clinically separate the two. But I think it's credible that if you do thorough neurological exams on sinus headache patients, you may find a number have other types of neurogenic headaches."

There are many types of primary headaches officially recognized by the International Headache Society. Sinus headache (without an infection) is not one of them. On the other hand, they do recognize headaches attributed to infections as a cause of headaches.

But Eross says that one in 10 patients actually does seem to have what he calls a NIRSH -- a non-infectious rhino-sinus headache.

Eross says that mild cases of NIRSH may be common. Since they're mild, headache specialists rarely see them. And Marple says that patients suffering disabling pain from these rhino-nasal headaches may get relief from surgery.

"In studies where researchers diligently ruled out migraine and cluster headache and other neurogenic headaches -- that one out of nine patients in the Eross study -- if you do surgery on them, there appears to be a real improvement," he says.

Getting the Right Help

If you are missing work or your child is absent from school because of a sinus headache, you need professional help. But which professional you see makes a difference.

The 100 patients in the Eross study went to an average of four doctors each -- and still went on suffering. Relatively few got to a headache specialist: 64% saw their family doctor, 59% saw an ear-nose-throat (ENT) specialist, 25% saw an allergist, and only 19% saw a neurologist.

"Among folks who saw neurologists, 83% got a [correct] migraine diagnosis," Eross says. "Among those who saw ENTs, only 8.1% got a migraine diagnosis. Only 6.3% got a migraine diagnosis from an allergist."

Most health plans require patients to see a general practitioner first. Eross says it's important to ask for a referral to a headache specialist if you get frequent or disabling headaches.

Eross ended up treating about half of the "sinus headache" patients in his study.

"Most of them have dramatically improved with migraine management," he says.

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SOURCES: Eross, E.J. "Why Migraine Is Misdiagnosed as Sinus Headache," American Headache Society 46th Annual Scientific Meeting, conference proceedings, Vancouver, British Columbia, Canada, June 10, 2004. News release, American Headache Society. Eric Eross, DO, associate consultant in neurology, Mayo Clinic, Scottsdale, Ariz. Bradley Marple, MD, chair, rhinology and paranasal sinus committee, American Academy of Otolaryngology -- Head and Neck Surgery (AAO-HNS); and vice chair, department of otolaryngology, University of Texas Southwest Medical Center, Dallas.
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