29 June 2004

Is it a migraine or sinusitis?

Despite what your doctor might tell you, migraines often masquerade as sinus headaches, a new study shows.

Despite what your doctor might tell you, migraines often masquerade as sinus headaches, a new study shows.

Nearly nine in 10 people who think they have sinus headaches are really having migraines, Mayo Clinic researchers reported June 10 at the American Headache Society's annual meeting in Vancouver, British Columbia.

The bad news is that some sufferers may be taking too many unnecessary over-the-counter sinus medications because of the missed diagnosis, the researchers said.

"Most folks who come into the clinic with a self-diagnosed or physician-diagnosed sinus headache actually don't have sinus headache at all," said lead researcher Dr Eric Eross, an associate consultant in neurology from the Mayo Clinic in Arizona.

How the study was conducted
In their study, Eross and his colleagues examined 100 people who answered a newspaper ad seeking people who thought they had sinus headache. Each patient had an extensive evaluation and some had imaging tests.

The researchers found that 63 percent were actually suffering from migraines, 23 percent had probable migraine and nine percent had headaches that couldn't be classified. The patients with unclassified headaches probably have sinus headache, Eross noted.

In addition, three percent had headaches secondary to a sinus infection, one percent had cluster headaches and one percent had hemicrania continua, a rare type of chronic headache, he added.

On average, the people who actually had migraine had gone 25 years without a correct diagnosis, Eross said. About 6 million South Africans suffer from migraines.

Many not getting the right treatment
"Most folks who think they have sinus headache are most likely using sinus medication to treat what is really migraine, and so they are not getting the appropriate and most effective treatment," Eross said.

Ninety-five percent of the patients were taking some medication: 33 percent were taking ibuprofen and naproxen; 25 percent were taking acetaminophen; 21 percent were taking other non-prescription pain relievers, 21 percent were taking non-prescription sinus medications and 9,5 percent were taking triptans.

Triptans are the most effective migraine prescription medications available, Eross noted. Those taking triptans had the best results by far, he added. In the study, 92 percent of the people were candidates for triptans, but only 12 percent were actually taking them the researchers said.

Importance of seeing a specialist
If you think that you have sinus headaches, he said, most probably you have migraines. "Make sure you see someone who specialises in headache, either a headache specialist or neurologist," he stressed.

One expert said the findings mirror her experience.

"The results of this study of sinus headache are very consistent with my clinical experience," said Jeanetta Rains, a headache specialist from Elliot Hospital and Dartmouth Medical Center. "Quite often, these individuals have undergone extensive treatments for allergies, sometimes sinus surgeries etc., only to discover that their chief complaint of headaches persists."

"Patients and physicians may have a difficult time sorting out the overlapping symptoms. I think the bottom line for patients and physicians alike, when symptoms persist despite our best efforts at treatment, sometimes we need to take a step back and reconsider our diagnoses and appreciate that it may be difficult to discriminate among the various types of headache," she added.

Weather considered
Results of another study presented at the same meeting showed that, while weather is often the trigger for a migraine, many more people believe weather changes trigger their migraine than is actually the case.

Among the 77 migraine patients in the study, the researchers found that 51 percent were actually sensitive to weather, but 62 percent thought they were sensitive to weather.

Of those whose migraines were triggered by weather, 34 percent were sensitive to temperature or humidity, 14 percent to a changing weather pattern and 13 percent to a change in barometric pressure, and one in 10 were sensitive to more than one type of weather change. – (HealthDayNews)

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Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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