An Otolaryngology, Neurology, Allergy, and Primary Care Consensus on Diagnosis and Treatment of Sinus Headache

Abstract

While "sinus" headache is a widely accepted clinical diagnosis, many medical specialists consider it to be an uncommon cause of recurrent headaches. Unnecessary diagnostic studies, surgical interventions, and medical treatments are often the result of the inappropriate diagnosis of sinus headache. Both the International Headache Society and the American Academy of Otolaryngology-Head and Neck Surgery have attempted to characterize conditions leading to headaches of rhinogenic origin. However, they have done so from different perspectives and in isolation from the other specialty groups. An interdisciplinary ad hoc committee recently convened to discuss the role of sinus disease and the nose in the etiology of headache and to review recent epidemiologic studies suggesting that sinus headache (headache of rhinogenic origin) and migraine are frequently confused with one another. Clinical trial data are presented which clearly indicate that the majority of sinus headaches can actually be classified as migraines. This committee reviewed scientific evidence available from multiple disciplines and concludes that considerable research and clinical study are needed to further understand and explain the role of nasal pathology and autonomic activation in migraine and headaches of rhinogenic origin. However, there was a consensus from this group that greater diagnostic and therapeutic attention needs to be given to patients complaining of sinus headache that may indeed be due to the nose.

Differences and Similarities between Allergic and Nonallergic Rhinitis in a Large Sample of Adult Patients with Rhinitis Symptoms

“…However, our data demonstrate that the frequency of recurring headaches in patients without sinusitis was very low and that the patients with recurring headaches had more severe nasal obstruction as measured by PNIF. These data are consistent with the finding of other authors [18]. …”

Migraine misdiagnosis as a sinusitis, a delay that can last for many years

“…Headaches located in the frontal, supraorbital, or infraorbital region are sinus headaches [9]. These headaches are usually recurrent, non-seasonal, and unassociated with fever, localized tenderness, or erythema [10]. …”

A randomized trial examining the effect of pretreatment point‐of‐care computed tomography imaging on the management of patients with chronic rhinosinusitis symptoms

“…These treatments differ significantly from that of chronic sinusitis therapy, as migraine therapy emphasizes the use of migraine preventive and abortive medications whereas rhinitis therapy emphasizes identification of rhinitic triggers, immunomodulation, and other pharmacologic interventions. 8,17 In light of recent studies demonstrating particularly high rates of antibiotic overutilization in treating sinusitis, the results of this diagnostic randomized trial illustrate the extent to which pretreatment CT scan can help otolaryngologists avoid fostering drugresistant microorganisms and reduce the risks of side effects from unindicated antibiotics. 10 Due to the small size of this clinical trial, study design and the high rate of medical noncompliance, this study was unable to measure the effect of a pre-CT scan on therapeutic success.…”