Sinuses Giving You a Headache? It's Probably Migraine.

Patient Expert

Many people self diagnose themselves or are even told by doctors that some of their headaches, especially those that are accompanied by facial pain in the sinus area are "sinus headaches."

If you've tried various over-the-counter sinus medications to relieve your sinus headaches to no avail, there may be a good reason...

It's probable that you don't have a sinus headache at all. Nearly 9 in 10 people with sinus headache symptoms likely are suffering from Migraines, suggests a study being presented at the 46th Annual Scientific Meeting of the American Headache Society (AHS).

"It's not surprising that people are convinced they have sinus headaches, because they often have nasal congestion, pressure or pain in the forehead or just below the eyes, and red or puffy eyes... It's guilt by association. Much of the pain or pressure is in the face, on both sides, so it doesn't occur to them that this might be a Migraine."

lead investigator Eric Eross, D.O. associate consultant in neurology; Mayo Clinic; Scottsdale, Arizona

Because they wrongly believe their Migraines are sinus headaches, some sufferers may be taking too many over-the-counter sinus medications inappropriately. In actuality, a sinus headache is rare in the absence of infection.

A Migraine can inflame the trigeminal nerve. The trigeminal nerve has branches in the face, One runs above they eyes, one runs along the sinuses, and the third runs along the lower jaw. As a result, the pain may be felt near the sinuses, which are air pockets between bone in the lower forehead, cheeks and behind the nose.

If you get what you think are sinus headaches, it's important to be evaluated by a headache specialist, said Dr. Eross. On average, each of the 100 patients in the study had seen more than four physicians for their headaches and had gone an average of 25 years without receiving the correct diagnosis - or significant relief.

AT A GLANCE

  • If you think you have a sinus headache, chances are it's actually a Migraine, suggests a Mayo Clinic Scottsdale study.

  • Pain or pressure on both sides of the face, a runny nose and red or puffy eyes are likely symptoms of Migraine.

  • The most effective Migraine medications are triptans. Unless there are signs of a sinus infection, antibiotics should not be prescribed.

  • More than 35 million Americans suffer from Migraines.¹

"It was hard to convince some of them that they actually suffered from Migraine headaches," said Dr. Eross. "Many were shocked."

About 12 percent of the U.S. population - or more than 35 million people - suffer from Migraines.1

One of 10 people in the study knew they suffered from Migraines, but thought they had sinus headaches in addition. They actually suffer from two different types of Migraines, one with sinus symptoms, one without, said Dr. Eross. While many got some pain relief by using non-prescription medications, such as ibuprofen or acetaminophen, Migraine-specific medications would be much more helpful, he said.

"Real" sinus headaches are almost always a side effect of a sinus infection, which is a very common ailment: 37 million Americans get at least one sinus infection every year, according to the American Academy of Otolaryngology - Head and Neck Surgery. Typical symptoms of a sinus infection are fever, swollen lymph nodes and a persistent green or yellow nasal discharge. If you don't have those symptoms and you've got the headache, you likely have Migraines, said Dr. Eross.

Ironically, researchers believe a few of the people in the study may have acquired sinus infections as a result of having a Migraine. Lengthy Migraine attacks can lead to swollen nasal membranes and closed off sinus passages, creating the perfect environment for an infection, said Dr. Eross.

But by far the majority of people in the study did not have sinus infections, and some had unnecessarily been prescribed antibiotics.

The study - called the Sinus Allergy & Migraine Study (SAMS) - included the first 100 people to answer an ad in the local newspaper asking for people who thought they had sinus headache. Each underwent an extensive 90-minute evaluation by researchers and some had imaging tests. Experts determined:

  • 63 percent were suffering from Migraines,
  • 23 percent had probable Migraine,
  • 9 percent had headaches that couldn't be classified,
  • 3 percent had headaches as a result of a sinus infection,
  • 1 percent had cluster headaches and
  • 1 percent had hemicrania continua, a rare type of chronic headache.

Although the International Headache Society (IHS) doesn't list sinus headache (without an infection) as a classification of headache, the researchers suggest there actually may be such a thing, if uncommon, and called it NIRSH - noninfectious rhino-sinus headache. Researchers believe the 9 people whose headaches didn't meet any IHS classifications actually suffer from NIRSH.

Of the 100 participants:

  • 98 percent said they had pain over their sinuses,
  • 97 percent said they had pain in the face,
  • 83 percent said the weather influenced their headaches,
  • 78 percent said their physicians had diagnosed them as having sinus headaches,
  • 76 percent said sinus medication helped,
  • 73 percent said they had a runny nose with the headaches,
  • 71 percent said their headaches varied with the seasons and
  • 67 percent said allergies affected their headaches.

SAMS researchers also analyzed the 63 people diagnosed with Migraine. Among their findings:

  • 56 percent had nasal congestion, 37 percent had eyelid puffiness, 25 percent had a runny nose, 22 percent had red eyes, 19 percent had tearing, and 3 percent suffered from droopy eyelids.
  • 57 percent had Migraine pain first, which eventually triggered the sinus-like symptoms, while 33 percent had sinus-like symptoms first, possibly triggering the Migraine. Headaches were triggered by weather changes for 83 percent, 73 percent said they noticed seasonal variations in their headaches, 62 percent said their headaches were triggered by a specific allergen and 38 percent noticed a change in altitude had an effect on their headaches. "This study suggests we should appreciate the role the change of seasons may play in Migraine," said Dr. Eross. "It also suggests allergies may trigger Migraines."
  • The study participants had to wait an average of 25 years before receiving the correct diagnosis of Migraine - in most cases by SAMS investigators. Researchers calculated that the average direct cost in seeking a correct diagnosis was $2,831.06 per person, including consultations with various doctors and undergoing diagnostic tests such as sinus imaging studies.
  • Slightly more than half (51 percent) were severely affected as a result of their headaches, including missed days from school, or work, work around the house or social events - and 21 percent were moderately affected, as determined by a Migraine disability score.
  • The majority (95 percent) were taking some sort of medication: 33 percent were taking non-steroidal anti-inflammatories (NSAIDS) such as ibuprofen and naproxen; 25 percent were taking acetaminophen; 21 percent were taking other non-prescription pain relievers, 21 percent were taking non-prescription sinus medications (antihistamines) and 9.5 percent were taking triptans, which are the most effective Migraine-specific prescription medications. When asked how beneficial the medications were, the triptans came out on top, far ahead of the next most helpful medicine, antihistamines.

"We determined that 92 percent of these people were candidates for triptans, but only 12 percent were using them," said Dr. Eross. "As headache specialists, we need to do a better job at educating patients and primary care physicians about the sinus-symptom phenomenon."

Dr. Eross's SAMS co-investigators are D.W. Dodick, and J.P. Gladstone.

The American Headache Society (AHS), founded in 1959 as the American Association for the Study of Headache, is based in Mt. Royal, N.J. AHS is a professional organization for those interested in the study and management of headache and face pain. AHS has approximately 2,500 members. For more information, visit the AHS Web site at http://www.ahsnet.org/. To fill the need for patient education, AHS established the American Council for Headache Education (ACHE), a non-profit patient-physician organization for the advancement of the treatment and management of headache and the encouragement of more constructive social attitudes toward the disease. Individuals who would like more information about headache, who would like a referral to a specialist who treats headache or who would like information on support groups can call (800) 255-ACHE at 19 Mantua Road, Mt. Royal, N.J. 08061, or visit the ACHE Web site at http://www.achenet.org/.

1 According to the World Health Organization, 6% of men and 18% of women have Migraine disease. Applying those percentages to statistics from the United States Census Bureau, determines that there are more than 35 million Migraineurs in the United States.


Resources:

Platform Presentation. 46th Annual Scientific Meeting of the American Headache Society (AHS). June, 2004.