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Is your “Sinus Pain” actually Migraine

 Headache Is often misdiagnosed as a sinus disease because it is under-appreciated that headache may be accompanied by symptoms that are similar to sinusitis:  lacrimation, conjunctival redness, runny nose, pain in the sinus region can all accompany headache/ migraine.

Cranial autonomic symptoms occur by activation of the trigeminal-autonomic reflex. Parasympathetic efferents that innervate the lacrimal glands and the nasal mucosa, produce “sinusitis-like” symptoms.

 A 2013 study stated that  81.5% of migraine-type headaches were misdiagnosed and managed as sinusitis. (1)

Schreiber and colleagues which included approximately 3000 patients with a history of self-described or physician diagnosed “sinus” headache and they determined that 80% of patients met ICHD criteria for migraine.(2)

This misdiagnosis can lead to years of suffering. Eross and colleagues found that their patients waited 25.3 years (longest of 62 years) prior to the correct diagnosis.(3) 

Even with advances in technology, misdiagnosis may still occur. It appears that healthcare practitioners need to review or revise the subject of neuroanatomy. In a 2008 study, the majority of patients had at least one investigation(endoscopy or CT scan) looking at the sinuses which were all normal. These patients were still diagnosed with “sinus headache” and over 50% of them were diagnosed with migraine at a later date.(4.)

  1. Al-Hashel, J.Y., Ahmed, S.F., Alroughani, R. et al. Migraine misdiagnosis as a sinusitis, a delay that can last for many years. J Headache Pain 14, 97 (2013).
  2. Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Pharm D, BCPS; Powers C: Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “Sinus” headache. Arch Intern Med 2004, 164: 1769–1772. 10.1001/archinte.164.16.1769
  3. Eross E, Dodick D, Eross M (2007) The Sinus, Allergy and Migraine Study (SAMS). Headache 47:213–224
  4. Mehle ME, Kremer PS (2008) Sinus CT scan findings in “Sinus Headache” migraineurs. Headache 48:67–71