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Sinus Headache or Migraine?

Expert says most mistake source of pain

FRIDAY, May 11 (HealthScout) -- That throbbing pain and pressure in your forehead you call a sinus headache may in fact be a migraine, says a study by a Missouri neurologist.

But don't throw out all your over-the-counter sinus medication just yet. A professor of neurology in Philadelphia says the study was poorly done, recruiting people who had no evidence of sinus disease but who did have symptoms of migraine.

The idea for the study came from talks with his patients, says Dr. Curtis Schreiber, a neurologist at the Headache Care Center in Springfield, Mo. "They'd tell me, 'I've got these darn sinus headaches,' and while some of the symptoms certainly were consistent with sinus headaches, they had other symptoms, too."

Schreiber recruited 30 patients, ages 18 to 65, who said they had sinus headaches but had never been diagnosed with a migraine. After a review of their medical histories and clinical examinations, the patients evaluated their own headache pain, then filled out a questionnaire rating how happy they were with their current treatment.

"What we found was that 97 percent of these patients had symptoms that fulfilled the International Headache Society's diagnostic criteria for migraine headaches," Schreiber says. "We also found in this group of patients that they had sinus symptoms. About three-quarters had nasal stuffiness, two-thirds had sinus drainage, and about 57 percent had the onset of their headaches when there were changes in the weather."

"But they also had other symptoms," Schreiber says. "Ninety-seven percent had moderate-to-severe headaches, two-thirds had sensitivity to light, and 63 had headaches on one side or headaches that were worsened by activity, which are classic signs of a migraine. In addition, two-thirds of the patients were nauseated, and one-half had headaches of a pulsating character, also signs of a migraine."

The problem may have been a nerve in the forehead, cheeks and jaw, Schreiber says. "Migraine causes inflammation of the nerves and blood vessels in the head. In the typical migraine headache, the upper branches of the nerve, which supply the coverings of the brain, are involved, and head pain is the predominant symptom. What may actually be happening in many cases of sinus headache is inflammation starts within the lower branches of the nerve, causing sinus symptoms to be predominant at the start of the headache."

"The central message here is that this group of 30 subjects had overlap between sinus and migraine headaches," Schreiber says. "This group was self-diagnosing, and it was not so much that they had made an error, [but that] the symptoms they were experiencing can masquerade or overlap."

Schreiber presented his findings this week at the 53rd annual meeting of the American Academy of Neurology in Philadelphia.

Migraines affect about 28 million Americans, yet only 48 percent of patients have been diagnosed with the ailment, reports the International Headache Society.

While Schreiber's observations "may be accurate, this is a very poor study," says Dr. Stephen Silberstein, professor of neurology at Jefferson Headache Center at Thomas Jefferson University in Philadelphia.

"To be a patient in the study you had to have no evidence of sinus disease … , and you had to have one of the major signs of migraine headaches. So does it surprise you that the patients had migraines?" " Silberstein asks.

What To Do

For more information on migraines, check the American Academy of Neurology and the Journal of the American Medical Association's Migraine Information Center.

And read these HealthScout stories on migraines.

SOURCES: Interviews with Curtis Schreiber, M.D., neurologist, Headache Care Center, Springfield, Mo.; Stephen Silberstein, M.D., professor of neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia; May 9, 2001, presentation to 53rd annual meeting of the American Academy of Neurology in Philadelphia
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