Causes of headache in patients with a primary diagnosis of sinus headache

Abstract

Headache is a common occurrence among the general population. Although the pain could be a symptom of acute sinusitis, chronic sinusitis is not considered as a usual cause of headache. In addition, autonomic-related symptoms in the sinonasal region may be associated with vascular pain. Confusion regarding these symptoms could lead to an incorrect diagnosis of sinusitis. A prospective cross-sectional study was conducted at two tertiary referral centers with residency programs in otorhinolaryngology, head and neck surgery and neurology. The study included 58 patients with a diagnosis of "sinus headache" made by a primary care physician. Exclusion criteria were as follows: previous diagnosis of migraine or tension-type headache; evidence of sinus infection during the past 6 months; and the presence of mucopurulent secretions. After comprehensive otorhinolaryngologic and neurologic evaluation, appropriate treatment was started according to the final diagnosis and the patient was assessed monthly for 6 months. The final diagnoses were migraine, tension-type headache and chronic sinusitis with recurrent acute episodes in 68, 27 and 5% of the patients, respectively. Recurrent antibiotic therapy was received by 73% of patients with tension-type headache and 66% with migraine. Sinus endoscopy was performed in 26% of the patients. Therapeutic nasal septoplasty was performed in 16% of the patients with a final diagnosis of migraine, and 13% with tension-type headache. Many patients with self-described or primary care physician labeled "sinus headache" have no sinonasal abnormalities. Instead, most of them meet the IHS criteria for migraine or tension-type headache.

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

“…However, migraine headache improved in 68.9% after proper diagnosis and treatment. These results are similar to that of Foroughipour and colleagues [17] who reported that recurrent antibiotic therapy was received by 66% patients and therapeutic nasal septoplasty was performed in 16% of the patients with a final diagnosis of migraine.…”

“…We are in agreement with Foroughipour and colleagues [17] who studied 58 patients with the diagnosis of sinusitis made by a primary care physician. After comprehensive otorhinolaryngologic and neurologic evaluation, the final diagnoses was migraine in 68% of the patients.…”

“…The diagnostic delay in our cohort could be explained by the presence of sinus pain, sinus congestion and nasal discharge during headache attacks. These symptoms have been reported with previous studies which concluded that presence of autonomic symptoms during migraine attacks often leads to confusion and incorrect diagnosis of sinusitis [16,17]. The ICHD criteria do not highlight the presence of cranial autonomic symptoms in the disorder, or perhaps more usefully comment upon them.…”

The aetiology underlying sinus headaches

“…The reported proportion of patients who did not benefit from treatment of rhinosinusitis is as high as 80%. 1,5 Six patients with a final diagnosis of migraine and three with tension-type headache in the present study had previously undergone unnecessary surgical interventions.…”

“…Neurovascular eventbased headaches, which develop as a result of diseases other than sinonasal pathologies but present with similar symptoms (namely, rhinorrhoea, nasal obstruction and tearing) are often evaluated as rhinosinusitis. 1,6 Many patients are wrongly treated with either medical or surgical approaches and, despite these different interventions, their symptoms persist. 5,7 Some authors suggest, however, that sinonasal contact points may evoke sinus headaches in some patients, and that these patients may benefit from surgical interventions.…”