More than 3,000 patients studied: sinus headache complaints may really mean migraine.(Clinical Rounds)

RANCHO MIRAGE, CALIF. -- Patients who think they have a sinus headache may actually be suffering from a migraine, Dr. Roger K. Cady said at a meeting sponsored by the Diamond Headache Clinic.

Migraine presentations can vary in real-life clinical settings, leading the doctor as well as the patient to think the problem is a sinus headache. But in his experience, at least 80% of patients in a general practice who experience episodic, recurrent headaches that they attribute to sinus infection or congestion will fulfill the diagnostic criteria for migraine, said Dr. Cady, a headache specialist in Springfield, Mo.

Clinicians should consider migraine as a likely diagnosis in patients who complain of sinus headaches but have no other symptoms of sinus infection, such as fever or purulent nasal discharge. Even patients with a runny nose; itchy, watery eyes; and a feeling of pressure in the sinuses as well as a headache may actually turn out to have a migraine if, on closer evaluation, they have symptoms such as moderate to severe pain intensity, unilateral pain, and photophobia.

Dr. Cady cited three recent studies of people with self-diagnosed sinus headaches. Overall, 93% of the patients turned out to meet International Headache Society (IHS) criteria for migraine or migrainous headache, and 67% responded to open-label treatment with 50 mg sumatriptan within 2 hours.

The first study, conducted by Dr. Cady and Dr. Curtis P. Schreiber, was a pilot study in patients who had experienced at least six sinus headaches over the preceding 6 months. They excluded patients who had previously been diagnosed with migraine, who used triptans, or whose headaches occurred in association with ...