Dr. Kari is absolutely correct in her findings, he said.
Explore This IssueJune 2008
In presentation of her prospective trial results, Dr. Kari noted that sinus headache is a common diagnosis given to the patient with facial pressure or pain. However, she added that sinus headache appears to be overdiagnosed and overtreated, and that it is a common chief complaint in otolaryngology and often involves surgical intervention.
Dr. Kari said that the Rhinosinusitis Task Force of the American Academy of Otolaryngology-Head and Neck Surgery includes facial pain or pressure as a major diagnostic symptom of sinusitis when present in conjunction with one of the other major symptoms, such nasal obstruction, nasal discharge, hyposmia or anosmia, or fever in acute rhinosinusitis. Minor factors include headache, halitosis, dental pain, cough, and facial fullness or pressure.
The International Headache Society defines migraine as two attacks fulfilling the following criteria if aura is present:
- A headache that lasts four to 72 hours;
- Headaches that have two or more of the following factors: unilateral, pulsating, moderate-severe intensity, aggravated by or causing avoidance of routine physical activity;
- One of the following occurs during headache: nausea, vomiting, photophobia, or phonophobia; and
- Headache cannot be attributed to another disorder.
Dr. Kari said that their results suggest that an empiric use of triptans in CT-negative patients might lead to relief of pain-indicating that the original diagnosis of sinus headache is incorrect, in fact, and migraine headache is the correct diagnosis.
Structure of the Study
Drs. Kari and DelGaudio enrolled 55 patients in their study, but only two-thirds completed the treatment. There were 37 women and 18 men in the study, reflecting the natural preponderance of migraine among women. The patients’ median age was 39. Patients were instructed to treat every headache.
Patients were followed up within one to three months, at which time they returned the headache diaries logging response to triptan therapy to each headache.
I need to emphasize that we had a highly selected study population, Dr. Kari said. In fact, 73% of the patients enrolled met International Headache Society criteria for migraine. Of those 41 patients, 31 met criteria for migraine but had not been previously diagnosed with migraine.
About 82 percent of the patients in our study had a significant reduction in headache with triptan use, she said. However, she did note significant attrition, as nearly a third of enrolled patients did not follow up. Many of the patients did not follow up because there was a significant resistance to believing a diagnosis of migraine headache. Many people consider migraine headaches only in the setting of a debilitating headache, which many of these patients did not have. Also, these patients have been treated for years by other physicians for presumed sinus headaches, and they were unwilling to believe that all of these previous diagnoses were incorrect, she said.