The Pain Blog
Latest News on the Science of Pain

 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). https://doi.org/10.1186/1129-2377-14-97
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

Sleep & Weight Loss.

Imagine losing weight while you sleep. Simple as that.

Well, a recent paper discusses this topic and it appears that quality sleep does play a major role in weight regulation. I have summarised the findings below.

Sleep–wake cycles exert a strong effect on the circulating levels of ghrelin and leptin, hormones that regulate appetite and calorie intake. 

Short sleep duration may be associated with an increase in the hormone ghrelin, which stimulates hunger, and a decrease in the hormone leptin ( the “feeling full” hormone. This leads to increased food intake to combat fatigue or stress, among other possible mechanisms. 

Poor sleep undermines dietary efforts to reduce weight by altering the levels of appetite-regulating hormones, leading to a reduction in dietary compliance. 

An increase in sleep duration and correction of sleep disorders may be accompanied by a better balance of the hormones that regulate appetite, with enhanced glucose tolerance, and a reduction in the level of the “stress hormone” cortisol.

To find out more read this interesting 2022 article:

Papatriantafyllou E, Efthymiou D, Zoumbaneas E, Popescu CA, Vassilopoulou E. Sleep Deprivation: Effects on Weight Loss and Weight Loss Maintenance. Nutrients. 2022 Apr 8;14(8):1549. doi: 10.3390/nu14081549. PMID: 35458110; PMCID: PMC9031614.

 Nowadays we must aim to follow the biopsychosocial model of pain management. Therefore it is best where possible to involve a multidisciplinary team approach. Chronic pain takes over a patient’s life, they insulate themselves, to protect themselves from further pain. They are afraid to leave their cocoon and in taking this approach pain mechanisms become more and more engrained in their psyche. This mental and often physical isolation leads to a further decline in mental health.

The first step should be to educate the patient. Educating the patient on pain mechanisms, in particular the fact that pain does not necessarily mean you are injuring yourself further, empowers the patient to take control of their situation. The importance of exercise and stretching, diet, and sleep must be emphasized. There is no quick fix for pain, treatment involves lifestyle change and it is a holistic approach.

As we know, “chronic pain can change the brain”. Where a psychological component exists it is important to bring a psychologist on the treating team.

I feel the following sentence from the cited paper sums up the  modern approach:

“ Biopsychosocial treatment that acknowledges and aims to address the physical, psychological and social factors underpinning pain and disability is currently accepted as the most effective approach to chronic pain (Gatchel et al., 2007; Meeus et al., 2016) and superior to stand‐alone physical therapy such as exercise or physiotherapy (Kamper et al., 2014).”

An essential lecture on this topic is that given by pain specialist Dr. Howard Schubiner. Breakthrough with Healing Chronic Pain | Howard Schubiner | Talks at Google

Dr. Schubiner’s saying “the reign of pain lies mainly in the brain” must be our mantra!