ORLANDO, FL-Researchers recommended that otolaryngologists might empirically treat selected patients with sinus headaches as if these patients actually had migraines, following study results illustrating that the use of triptans brought relief to more than 80% of these individuals.
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June 2008Our data support the idea that otolaryngologists should consider migraine when we are evaluating sinus headaches, said Elina Kari, MD, a medical house officer in the Department of Otolaryngology at Emory University in Atlanta. She presented her paper at the 111th annual meeting of the Triological Society, held at the Combined Otolaryngology Spring Meeting.
This study demonstrated that the demographics of patients with self-described ‘sinus headaches’ who did not have findings of sinusitis on endoscopy and CT scan closely reflected the demographics of patients afflicted with migraines, Dr. Kari said.
Of the 38 patients who were able to complete the study, 31 achieved a 50% or greater relief in headache symptoms while on triptan drugs. The patients were assigned to take eletriptan 40 mg upon onset of perceived sinus headache pain, and were instructed to repeat the dose within two hours if the headache was not adequately relieved. If eletriptan was ineffective, patients were switched to sumatriptan or rizatriptan. Seven of the 38 patients, in fact, were successfully treated with a trial of these other drugs because of an inadequate response to eletriptan.
Dr. Kari said that one additional patient reported between a 25% and 50% reduction in pain symptoms. Another three patients achieved significant reduction in pain relief by following non-triptan migraine-directed therapy with lifestyle or diet changes. Three patients reported no change in symptoms with eletriptan use.
The vast majority of these patients who completed the trial-82 percent-had a significant improvement in pain relief, she said.
Patients eligible for the trial were those who presented to the practice of the senior author, John M. DelGaudio, MD, at a tertiary care otolaryngology department with primary complaints of facial pain, pressure, or headache localized over the area of the sinuses, and a self- or physician diagnosis of sinus headache.
The participants underwent a directed history, physical examination including rigid nasal endoscopy, a sinus computer-assisted tomography (CT) scan, and completed a headache questionnaire. Those patients completed a headache diary for each headache using a visual analog scale to rate the headache before and after triptan use.
Our data support other studies that have looked at this topic, Dr. Kari said, although she noted differences in methodology in the other studies, including the use of a single agent at a single interval.
Implications for Diagnosis and Treatment
There is a tendency among primary care physicians to classify facial pain as a sinus headache. All these patients had negative sinus computed tomography findings, so we know they didn’t have sinusitis, said Harold C. Pillsbury, MD, Professor and Chair of Otolaryngology-Head and Neck Surgery at the University of North Carolina, Chapel Hill. Dr. Pillsbury, President of the Triological Society, was co-moderator of the session at which Dr. Kari presented her report.