A Textbook Case of Sinus Headaches?

[Guest guest]

A Textbook Case of Sinus Headaches? Don't Be So Sure.

Written by: Haran, CBS News

Published on: November 12, 2004   

You've probably heard friends or family members complaining of recurring

sinus headaches. Maybe you yourself feel that pressure over your sinuses on

a regular basis. If you or others you know experience these types of

headaches routinely, new research suggests that what you may actually have

is migraine headaches.

" There is a great under-recognition of migraine, " says Curtis Schreiber, MD,

associate director of the Headache Care Center in Springfield, Missouri, who

led a study published in the September 13th issue of the Archives of Internal

Medicine.

In the study, Dr. Schreiber and his colleagues screened almost 3,000 people

who had a self-described or physician-diagnosed " sinus " headache,

specifically people who complained of intermittent headaches marked by

sinus pressure, pain and nasal congestion. They excluded patients with

obvious signs of sinus infection, such as fever or colored nasal discharge.

The researchers found that 88 percent of participants who thought they were

suffering from sinus headaches actually had a type of migraine headache.

Below, Dr. Schreiber discusses why there is so much confusion between

sinus and migraine headaches.

When do sinuses cause headache?

Headache can occur as part of an acute sinus infection. Infections of the

sinuses are commonly caused by viruses and bacteria. Typically, when

people have sinus infections, they develop a fever and colored nasal

discharge. Sinus infections are identified by these symptoms and sometimes

CT scans of the sinuses and laboratory tests.

The kind of " sinus " headaches that neurologists and headache doctors are

skeptical about are those that are episodic and recurrent. Although pain may

start over the sinus areas, other symptoms occur as the headache

progresses. A typical patient might say, " I get sinus headaches once every

month or every couple of weeks. I don't have fever with it. I really don't get

much discharge or drainage with it, but it starts over my sinuses and it gets to

be severe. "

In what way does a migraine look like sinus headache?

If you look at a headache textbook and read how migraine headache is

defined, you'll see a relatively small number of symptoms included in that

diagnostic definition. Those features include moderate to severe intensity,

throbbing pain, light sensitivity, sound sensitivity, nausea or vomiting, and

pain that worsens with routine physical activity. That's the mental checklist

that

clinicians are trained with, and it doesn't include " sinus " symptoms.

However, there is a group of migraine patients who start with sinus-area

symptoms. People might have nasal congestion or watery eyes. They might

have pressure over their cheek area or forehead. As the headache

progresses, it develops symptoms more typical of migraine, such as light

sensitivity or nausea. If you look at the study that we did, it showed that 88

percent of people with a history of " sinus " headache, without obvious

symptoms of infection, fulfilled a migraine-type diagnosis.

What are other reasons why a person might think their headache is a sinus

headache?

It's not uncommon for patients to say, " Sinus headaches run in my family. " But

usually, we don't think of infectious processes as having a genetic link. And

for women who say, " It seems like I get sinus headaches and they're worse

around my menstrual cycle, " we think about migraine, not infections. If you

look the patients with these self-described or previously clinician-diagnosed

sinus headaches that turned out to be migraines, the triggers often included

things such as weather changes, which can lead many sufferers to presume

that the attack was sinus related. In fact, weather changes are a frequently

encountered trigger for migraine headaches. Many headache sufferers notice

headaches seem to be worse in the spring and the fall, during the time typical

of seasonal allergies. This association also leads many to presume that their

headaches are sinus related.

What message can be taken from this study?

I think the message here is not that every person with sinus headache has

migraine. There are people who do have infections and other less common

sinus problems that need to be appropriately diagnosed and treated.

However, there are probably a lot of headache sufferers who have this sinus

presentation of migraine who limp along with it for a day or longer and miss

work, family and social activities on a regular basis.

Sufferers of this type of headache, and their healthcare providers, should

consider the possibility that this headache is a migraine. There may be as

much as a 9 out of 10 chance that it is migraine, and if so, a migraine-focused

treatment approach may provide more effective relief.

What advice do you have for people who suffer from these types of

headaches?

When people see their healthcare provider with headaches, they need to be

prepared to describe all of the symptoms that occur during the attack. How it

starts is important, but they should also be able to relate all of the symptoms

that occur with the headache. Be sure to relate the total duration, from start

until all of the symptoms are gone. Let your healthcare provider know about

the impact of the headache, the things that you normally do, but can't do when

the headache is there.

Patients need to be explicit about how well their treatment plan is working. All

too often, if a patient is asked, " How is your treatment working? " they say,

" Well, OK, I guess. " Many healthcare providers may presume that they are

doing really well when, in fact, the patient means, " I'm getting partial

relief. "

For patients with migraine, the modern goal for treatment is to become pain-

free and back to normal function within two hours of treating. For many

sufferers partially effective treatments reduce the symptoms but a return to

normal function is hours or days away.