Wrong Diagnosis of Sinus Headache Can Lead to Inappropriate Treatment

A consensus panel of physicians who treat patients reporting sinus and facial pain strongly recommend the use of all diagnostic tools available to determine the root cause of the headache-whether it is neurological or physiological, migraine or sinus. The physicians, including two otolaryngologists, four neurologists, and two allergists writing in an article published in Otolaryngology-Head and Neck Surgery (2006; 134(3):516-523), also agreed that the wrong diagnosis can lead to inappropriate treatment or lack of treatment.

Multidisciplinary Effort, Diverse Opinions

The consensus panel met in December 2003 to assess the current state of diagnosis and treatment for sinus headache. Although these physicians came together on the overall need for better diagnosis, they continue to have diverse opinions on the cause of these headaches.

The key point of contention is highlighted in the article. Many sinus headaches are migraines, said Michael Setzen, MD, Clinical Associate Professor of Otolaryngology at New York University School of Medicine in New York City and Chief of the Rhinology Section at North Shore University Hospital in Manhasset, NY. A significant proportion of what we now think of as sinus headaches are indeed migraine headaches, he added.

The ENT physician is obligated to rule out sinus as the cause of a headache. – Neil Bhattacharyya, MD

Headache specialists consider sinus headache to be relatively rare, even when there is demonstrable noninfectious sinus inflammation, wrote Dr. Setzen and his co-authors from the consensus panel. Otolaryngologists and allergists, who frequently evaluate patients complaining of headache and rhinogenic symptoms, recognize that sinus headache is often migraine and consider many additional pathologic disorders in the differential diagnosis of a patient experiencing recurrent episodes of sinus headache.

Dr. Setzen contends that the rhinogenic headache is more serious than what might be typically thought of as a sinus headache. He argues it may be a deviated septum with bone spurs. This condition is not routinely diagnosed and the patient is unlikely to get better without proper treatment, he added.

The Diagnostic Process

The ENT physician is obligated to rule out sinus as the cause of a headache, said Neil Bhattacharyya, MD, Associate Professor of Otology and Laryngology at Brigham and Women’s Hospital in Boston, Mass. There is wide variability in symptoms and manifestation of chronic sinusitis, he added. Everyone who has blocked sinuses will not have a headache and every headache is not a sinus headache. But the pendulum is swinging far beyond this to say that there is no such thing as a sinus headache, Dr. Bhattacharyya argues.