ESS Provides Better QOL for CRS Patients with Comorbid Migraine

Do patients with chronic rhinosinusitis (CRS), with and without a migraine history, experience comparable quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS)?

Background: CRS and migraine, both of which are common, have overlapping symptomatology. In patients with CRS, comorbid migraine can confound clinical decisions and QOL outcomes. Medically refractory CRS is effectively treated with ESS, a decision that is partly informed by clinical studies. But there is no way to discern preoperatively whether headache, facial pain and pressure, and nasal congestion are manifestations of a migraine or the direct result of sinonasal inflammation.

Study design: Retrospective analysis of a prospective cohort enrolled between September 2004 and November 2012.

Setting: Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health Sciences University, Portland.

Synopsis: A total of 229 patients with medically refractory CRS were prospectively evaluated following ESS using disease-specific QOL surveys. Patients were administered the Rhinosinusitis Disability Index (RSDI) and a second disease-specific QOL measure (either the Sino-Nasal Outcome Test-22 [SNOT-22] or the Chronic Sinusitis Survey [CSS]) at a pre-operative baseline assessment and at six-, 12-, and 18-month post-operative follow-up visits. Patients reporting a migraine history were more likely to be female, to report a history of allergy and fibromyalgia, and to have comorbid depression, and less likely to have nasal polyposis. They also reported a higher disease impact when compared to patients with no migraine history. Average RSDI physical and functional scores were worse at baseline in patients with a comorbid migraine history. Participants with and without a migraine history showed a statistically similar degree of improvement in all QOL measures between pre-operative and last post-operative assessments. Limitations included a need to collect disease-specific QOL constructs for both migraine or headache and CRS and a lack of a medical control patient group.

Bottom line: Patients with comorbid migraine and CRS are more likely to have less severe evidence of disease and worse pre-operative baseline QOL scores, but ESS provides comparable improvement for patients with and without comorbid migraine.

Citation: DeConde AS, Mace JC, Smith TL. The impact of comorbid migraine on quality-of-life outcomes after endoscopic sinus surgery. Laryngoscope. 2014:124:1750-1755.