Sinus headaches could actually be Migraine

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."

"A comprehensive 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," Kaniecki said.

"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 said.

"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," he added.

"Episodic tension-type 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.

"Migraine symptoms 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 said.