Wrong Diagnosis of Sinus Headache Can Lead to Inappropriate Treatment

Dr. Levine suggested that sinus disease can be a trigger for migraine headache and recommended new clinical research to determine this possibility. All migraine headache is caused by a neurological event and there is an entire spectrum of symptoms and possible neurological factors, he said. If the nose and its nervous system do not work properly these neurons can likely cause a migraine headache, said Dr. Levine.

As outlined, these otolaryngologists recommend the use of the nasal endoscopy and follow-up CT scan when rhinosinusitis is a definite possibility. Dr. Setzen recommended another interim step. The endoscopy does not allow the physician to see the entire nasal spectrum, but if this test does suggest sinus as the cause of headache pain, Dr. Setzen attempts to confirm the diagnosis with the application of a local anesthetic to contact points, along with a nasal constrictor. If this alleviates the headache in five minutes, it is powerful information to conclude that the contact point is the source of the headache, he explained.

Surgery a Last Resort

Because the usual treatment for chronic rhinosinusitis is surgery, these physicians recommend that all other treatment options be pursued before attempting surgery. All three warn that antibiotics currently are overused and should be limited to patients who have mucosal thickening, discolored nasal drainage, and opacification of sinuses.

Drs. Setzen and Levine recommend that a short-term course of migraine drug therapy may be initiated by the otolaryngologist. These treatments include several different triptans. They are recommended for patients who have headaches that occur less than once a week. These experts strongly discourage patients from taking over-the-counter pain medications such as ibuprofen more than two to three times per week since this overmedication can actually trigger rebound headaches.

Dr. Bhattacharyya said if the otolaryngologist rules out sinus related headache, the patient should be referred back to the neurologist. Medication for migraine headache is better managed by the neurologist who will provide long-term monitoring and follow-up for the different drug regimens, he said.

The overarching message of the consensus panel is this, said Drs. Levine and Setzen: A differential diagnosis of migraine and rhinogenic headache is necessary if a patient is to receive appropriate treatment.

©2006 The Triological Society