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

Abstract

BackgroundSinusitis is the most frequent misdiagnosis given to patients with migraine.Therefore we decided to estimate the frequency of misdiagnosis of sinusitis among migraine patients.MethodsThe study included migraine patients with a past history of sinusitis. All included cases fulfilled the International Classification of Headache Disorders, 3rd edition (ICHD-III- beta) criteria. We excluded patients with evidence of sinusitis within the past 6 months of evaluation. Demographic data, headache history, medical consultation, and medication intake for headache and effectiveness of therapy before and after diagnosis were collected.ResultsA total of 130 migraine patients were recruited. Of these patients 106 (81.5%) were misdiagnosed as sinusitis. The mean time delay of migraine diagnosis was (7.75 ± 6.29, range 1 to 38 years). Chronic migraine was significantly higher (p < 0.02) in misdiagnosed patients than in patients with proper diagnosis. Medication overuse headache (MOH) was reported only in patients misdiagnosed as sinusitis. The misdiagnosed patients were treated either medically 87.7%, or surgically12.3% without relieve of their symptoms in 84.9% and 76.9% respectively. However, migraine headache improved in 68.9% after proper diagnosis and treatment.ConclusionsMany migraine patients were misdiagnosed as sinusitis. Strict adherence to the diagnostic criteria will prevent the delay in migraine diagnosis and help to prevent chronification of the headache and possible MOH.

Identifying Natural Subgroups of Migraine Based on Comorbidity and Concomitant Condition Profiles: Results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

“…38 Similarly, neck pain may be a comorbidity of migraine if it has an independent etiology, or a manifestation of migraine if pain is referred to the upper cervical nerve routes. In some cases, apparent comorbid conditions may be manifestations of migraine per se.…”

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

“…A special attention should be given to cervicogenic headache and sinus headache for which CM is often misdiagnosed [17]. For the diagnosis of cervicogenic headache, evidence is needed that a disorder within the cervical spine or soft tissues of the neck, known to be able to cause headache, is present, as well as proof of a causal relation by temporal association, provocative manoeuvres or a diagnostic blockade [3].…”

Cranial Neuralgias, Sinus Headache, and Vestibular Migraine

“…1 However, a majority of physician-and/or patientdiagnosed "sinus headache" has in numerous studies been demonstrated to meet diagnostic criteria for migraine and respond to migraine-specific medications. 6,7 In the Sinus, Allergy, and Migraine Study (SAMS), more than half (52%) of 100 consecutively consulting patients believed they had sinus headache, but the results determined they had migraine with or without aura, and 23% had probable migraine. 8 In another study of 2991 patients with a history of selfdescribed or physician-diagnosed "sinus" headache and no previous diagnosis of migraine, 80% met International Headache Society (IHS) criteria for migraine without or with aura, and 8% met IHS criteria for migrainous headache.…”

“…Various studies have shown that when patients self-report their headaches as "sinus" in origin, physicians are more likely to agree with the diagnosis. 6,7 The lay term of "sinus headache" continues to be perpetuated in the media. Primary care physicians and patients alike appear to continue to prefer the choice of "sinus headache" as the medical term when patients experience facial pain or pressure À symptoms traditionally associated with sinus disease.…”