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Sinuses Giving You a Headache? It's Probably a Migraine.

Getting the right diagnosis is essential!

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Updated: August 10, 2006

AHS 46th Annual Scientific Meeting

If you've tried various over-the-counter sinus medications to relieve sinus headaches to no avail, there may be a good reason: nearly 9 in 10 people with sinus headache symptoms likely are actually suffering from Migraines, suggests a study presented at the 46th Annual Scientific Meeting of the American Headache Society (AHS).

"It's not surprising people are convinced they have sinus headaches, because they often have nasal congestion, pressure or pain in the forehead or just below the eyes, and red or puffy eyes," said lead investigator Eric Eross, D.O., associate consultant in neurology at the Mayo Clinic in Scottsdale, Ariz. "It's guilt by association. Much of the pain or pressure is in the face, on both sides, so it doesn't occur to them that this might be a Migraine."

If you get what you think are sinus headaches, it's important to be evaluated by a headache specialist, said Dr. Eross. On average, each of the 100 patients in the study had seen more than four physicians for their headaches and had gone an average of 25 years without receiving the correct diagnosis - or significant relief.

"It was hard to convince some of them that they actually suffered from Migraine headaches," said Dr. Eross. "Many were shocked." About 12% of the U.S. population - or 32 million people - suffer from Migraines.

One of 10 people in the study knew they suffered from Migraines, but thought they had sinus headaches in addition. They actually suffer from two different types of Migraines, one with sinus symptoms, one without, said Dr. Eross. While many got some pain relief by using non-prescription medications, such as ibuprofen or acetaminophen, Migraine-specific medications would be much more helpful, he said.

"Real" sinus headaches are almost always a side effect of a sinus infection, which is a very common ailment: 37 million Americans get at least one sinus infection every year, according to the American Academy of Otolaryngology - Head and Neck Surgery. Typical symptoms of a sinus infection are fever, swollen lymph nodes and a persistent green or yellow nasal discharge. If you don't have those symptoms and you've got the headache, you likely have Migraines, said Dr. Eross.

The study - called the Sinus Allergy & Migraine Study (SAMS) - included the first 100 people to answer an ad in the local newspaper asking for people who thought they had sinus headache. Each underwent an extensive 90-minute evaluation by researchers and some had imaging tests. Experts determined: 63% were suffering from Migraines, 23% had probable Migraine, 9% had headaches that couldn't be classified, 3% had headaches as a result of a sinus infection, 1% had cluster headaches and 1% had hemicrania continua, a rare type of chronic headache.

Of the 100 participants: 98% reported pain over their sinuses, 97% reported pain in the face, 83% said the weather influenced their headaches, 78% said their physicians had diagnosed them as having sinus headaches, 76% said sinus medication helped, 73% reported  a runny nose with the headaches, 71% said their headaches varied with the seasons and 67% said allergies affected their headaches.

SAMS researchers also analyzed the 63 people diagnosed with Migraine. Among their findings:

  • 56% had nasal congestion, 37% had eyelid puffiness, 25% had a runny nose, 22% had red eyes, 19% had tearing, and 3% suffered from droopy eyelids.
  • 57% had Migraine pain first, which eventually triggered the sinus-like symptoms, while 33% had sinus-like symptoms first, possibly triggering the Migraine. Headaches were triggered by weather changes for 83%, 73%  noticed seasonal variations in their headaches, 62% said their headaches were triggered by a specific allergen and 38% noticed a change in altitude had an effect on their headaches. "This study suggests we should appreciate the role the change of seasons may play in Migraine," said Dr. Eross. "It also suggests allergies may trigger Migraines."
  • 51% were severely affected as a result of their headaches, including missed days from school, or work, work around the house or social events - and 21% were moderately affected, as determined by a Migraine disability score.
  • 95% were taking some sort of medication: 33% were taking NSAIDS such as ibuprofen and naproxen; 25% were taking acetaminophen; 21% were taking other non-prescription pain relievers, 21% were taking non-prescription sinus medications, and 9.5% were taking triptans. When asked how beneficial the medications were, the triptans came out on top, far ahead of the next most helpful medicine, antihistamines.

"We determined that 92% of these people were candidates for triptans, but only 12% were using them," said Dr. Eross. "As headache specialists, we need to do a better job at educating patients and primary care physicians about the sinus-symptom phenomenon."

Dr. Eross's SAMS co-investigators are D.W. Dodick, and J.P. Gladstone.

For a more detailed version of this article, click HERE.

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