According to a University
of Pittsburgh neurologist writing in the March 19 issue of the Journal
of the American Medical Association, Migraine headaches are significantly
under-diagnosed by physicians.
"A review of a
number of studies suggests that far more people actually suffer
migraine headaches than popularly thought," said Robert Kaniecki,
assistant professor and director of the Headache Center at the University
of Pittsburgh Medical Center. "Many people who are diagnosed
as having tension or sinus headaches are, in fact, suffering migraines."
approach to migraine management involves steps taken to limit the
frequency of attacks and to address the individual headaches rapidly
and effectively," Kaniecki said.
One of the most over-diagnosed
forms of headache, according to Kaniecki, is the sinus headache,
which he says exists only in theory. Recent research has shown that
the majority of patients diagnosed with sinus headache actually
have headaches meeting criteria for migraine.
"The United States
is the only country in the world to have such a thing as sinus headache,"
Kaniecki said. "A study done in 2002 showed that of 3,038 people
who reported that they had sinus headaches, only eight actually
had sinus infections."
"Over 50 percent
of patients with migraine are undiagnosed, and in this group, 42
percent carry the label of sinus headache and 32 percent the diagnosis
of tension headache," Kaniecki said.
As a result of the
over-diagnosis of sinus headaches an excessive number of prescriptions
are written to treat the phantom sinus infection, including mass
doses of antibiotics and decongestants. This, he said, could be
a major contributor to antibiotic resistance.
A primary reason for
the under-diagnosis is a lack of physician education, Kaniecki said.
"Only 48 percent
of internal medicine and 62 percent of family practice residency
graduates report being very prepared to treat patients with headache,"
"The first step
is to find out if there are secondary origins of headache, such
as a brain tumor or aneurysm. We then assess the patient for a primary
headache subtype such as migraine, tension, or cluster," Kaniecki
"Once that step
is complete, we assess the frequency of episodes to determine whether
the patient has an episodic or chronic form of this headache,"
headache annually affects some 38 percent of U.S. adults, yet rarely
requires medical attention given the typical absence of disability
or concerning symptoms," Kaniecki said. The pain is generally
mild to moderate, usually bilateral, and nonthrobbing, with stress
as the most common trigger.
may be quite variable," he said. Although typically seen as
a one-sided throbbing headache associated with nausea and sensitivities
to light and noise, migraine also may be associated with neck pain
or sinus drainage and congestion.
"If one has a
stable pattern of disabling headache occurring as episodes over
months to years, it almost always represents migraine," Kaniecki