Migraine Misdiagnosis As a Sinusitis, a Delay That Can Last for Many Years

Overview

Journal J Headache Pain

Publisher Biomed Central

Date 2013 Dec 17

PMID 24330723

Citations 11

Authors

Jasem Y Al-Hashel

Samar Farouk Ahmed

Raed Alroughani

Peter J Goadsby

Affiliations

Soon will be listed here.

Abstract

Background: Sinusitis is the most frequent misdiagnosis given to patients with migraine.Therefore we decided to estimate the frequency of misdiagnosis of sinusitis among migraine patients.

Methods: The study included migraine patients with a past history of sinusitis. All included cases fulfilled the International Classification of Headache Disorders, 3rd edition (ICHD-III- beta) criteria. We excluded patients with evidence of sinusitis within the past 6 months of evaluation. Demographic data, headache history, medical consultation, and medication intake for headache and effectiveness of therapy before and after diagnosis were collected.

Results: A total of 130 migraine patients were recruited. Of these patients 106 (81.5%) were misdiagnosed as sinusitis. The mean time delay of migraine diagnosis was (7.75 ± 6.29, range 1 to 38 years). Chronic migraine was significantly higher (p < 0.02) in misdiagnosed patients than in patients with proper diagnosis. Medication overuse headache (MOH) was reported only in patients misdiagnosed as sinusitis. The misdiagnosed patients were treated either medically 87.7%, or surgically12.3% without relieve of their symptoms in 84.9% and 76.9% respectively. However, migraine headache improved in 68.9% after proper diagnosis and treatment.

Conclusions: Many migraine patients were misdiagnosed as sinusitis. Strict adherence to the diagnostic criteria will prevent the delay in migraine diagnosis and help to prevent chronification of the headache and possible MOH.

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References

Akerman S, Holland P, Goadsby P . Diencephalic and brainstem mechanisms in migraine. Nat Rev Neurosci. 2011; 12(10):570-84. DOI: 10.1038/nrn3057. View

Schreiber C, Hutchinson S, Webster C, Ames M, Richardson M, Powers C . Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Arch Intern Med. 2004; 164(16):1769-72. DOI: 10.1001/archinte.164.16.1769. View

Cady R, Schreiber C . Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology. 2002; 58(9 Suppl 6):S10-4. DOI: 10.1212/wnl.58.9_suppl_6.s10. View

Foroughipour M, Sharifian S, Shoeibi A, Ebdali Barabad N, Bakhshaee M . Causes of headache in patients with a primary diagnosis of sinus headache. Eur Arch Otorhinolaryngol. 2011; 268(11):1593-6. DOI: 10.1007/s00405-011-1643-6. View

Diamond M . The role of concomitant headache types and non-headache co-morbidities in the underdiagnosis of migraine. Neurology. 2002; 58(9 Suppl 6):S3-9. DOI: 10.1212/wnl.58.9_suppl_6.s3. View

Rossi P, Faroni J, Tassorelli C, Nappi G . Diagnostic delay and suboptimal management in a referral population with hemicrania continua. Headache. 2009; 49(2):227-34. DOI: 10.1111/j.1526-4610.2008.01260.x. View

. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013; 33(9):629-808. DOI: 10.1177/0333102413485658. View

Stewart W, Simon D, Shechter A, Lipton R . Population variation in migraine prevalence: a meta-analysis. J Clin Epidemiol. 1995; 48(2):269-80. DOI: 10.1016/0895-4356(94)00128-d. View

Vuillaume De Diego E, Lanteri-Minet M . Recognition and management of migraine in primary care: influence of functional impact measured by the headache impact test (HIT). Cephalalgia. 2005; 25(3):184-90. DOI: 10.1111/j.1468-2982.2004.00820.x. View

10.

Eross E, Dodick D, Eross M . The Sinus, Allergy and Migraine Study (SAMS). Headache. 2007; 47(2):213-24. DOI: 10.1111/j.1526-4610.2006.00688.x. View

11.

Dadgarnia M, Atighechi S, Baradaranfar M . The response to sodium valproate of patients with sinus headaches with normal endoscopic and CT findings. Eur Arch Otorhinolaryngol. 2009; 267(3):375-9. DOI: 10.1007/s00405-009-1090-9. View

12.

Barbanti P, Fabbrini G, Pesare M, Vanacore N, Cerbo R . Unilateral cranial autonomic symptoms in migraine. Cephalalgia. 2002; 22(4):256-9. DOI: 10.1046/j.1468-2982.2002.00358.x. View

13.

Mehle M, Kremer P . Sinus CT scan findings in "sinus headache" migraineurs. Headache. 2008; 48(1):67-71. DOI: 10.1111/j.1526-4610.2007.00811.x. View

14.

Goadsby P . Lacrimation, conjunctival injection, nasal symptoms... cluster headache, migraine and cranial autonomic symptoms in primary headache disorders -- what's new?. J Neurol Neurosurg Psychiatry. 2009; 80(10):1057-8. DOI: 10.1136/jnnp.2008.162867. View

15.

Levine H, Setzen M, Cady R, Dodick D, Schreiber C, Eross E . An otolaryngology, neurology, allergy, and primary care consensus on diagnosis and treatment of sinus headache. Otolaryngol Head Neck Surg. 2006; 134(3):516-23. DOI: 10.1016/j.otohns.2005.11.024. View

16.

May A, Goadsby P . The trigeminovascular system in humans: pathophysiologic implications for primary headache syndromes of the neural influences on the cerebral circulation. J Cereb Blood Flow Metab. 1999; 19(2):115-27. DOI: 10.1097/00004647-199902000-00001. View

17.

Viticchi G, Silvestrini M, Falsetti L, Lanciotti C, Cerqua R, Luzzi S . The role of instrumental examinations in delayed migraine diagnosis. Neurol Sci. 2011; 32 Suppl 1:S143-4. DOI: 10.1007/s10072-011-0520-9. View

18.

Perry B, Login I, Kountakis S . Nonrhinologic headache in a tertiary rhinology practice. Otolaryngol Head Neck Surg. 2004; 130(4):449-52. DOI: 10.1016/j.otohns.2004.01.005. View

19.

Ryan Jr R, Pearlman S . Common headache misdiagnoses. Prim Care. 2004; 31(2):395-405, viii. DOI: 10.1016/j.pop.2004.02.010. View

20.

Patel Z, Kennedy D, Setzen M, Poetker D, DelGaudio J . "Sinus headache": rhinogenic headache or migraine? An evidence-based guide to diagnosis and treatment. Int Forum Allergy Rhinol. 2012; 3(3):221-30. DOI: 10.1002/alr.21095. View