4/29/2013
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Sinus Headache vs.
Migraine
Sinus Headache vs.
Migraine
John M. DelGaudio, MD, FACS
Professor and Vice Chair
Chief of Rhinology and Sinus Surgery
Department of Otolaryngology
Emory University School of Medicine
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Sinus Headache vs. Migraine: A Comprehensive Comparison by John M. DelGaudio, MD, Slides of Clinical Medicine
An in-depth comparison between sinus headaches and migraines, written by Dr. John M. DelGaudio, a Professor and Vice Chair at Emory University School of Medicine. the differences and similarities between the two conditions, including symptoms, diagnosis, and treatment. It also discusses the Rhinosinusitis Task Force's definition of sinusitis and the classification of facial pain of rhinogenic origin.
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Sinus Headache vs.
Migraine
Sinus Headache vs.
Migraine
John M. DelGaudio, MD, FACS Professor and Vice Chair Chief of Rhinology and Sinus Surgery Department of Otolaryngology Emory University School of Medicine
Sinus Headache
Problems
Sinus Headache
Problems
- A common diagnosis given to the patient with facial pressure or pain - Over-diagnosed and over-treated - Common chief complaint in Otolaryngology - Can lead to unnecessary surgical intervention
EMORY HEALTHCAREEMORY HEALTHCARE
Rhinosinusitis Task Force: Sinusitis Defined
Rhinosinusitis Task Force: Sinusitis Defined MajorFactors Facial Pain/Pressure- MUST beassociated with ANOTHER major factor Facial Congestion/fullness Nasal Obstruction/blockage Nasal Discharge/drainage Hyposmia/anosmia Fever (in acute) MinorFactors Headache Fever Halitosis Fatigue Dental pain Cough Ear pain/fullness/pressure
http://www.powerpak.com/courses/10132/Figure3.jpg
EMORY HEALTHCAREEMORY HEALTHCARE Benninger^ et^ al (2003); Lanza and Kennedy (1997)
Facial Pain of Rhinogenic Origin Classification
Facial Pain of Rhinogenic Origin Classification
- Rhinosinusitis
- Inflammatory
- Barosinusitis
- Changes in atmospheric pressure (flying, scuba)
- Can it occur in normal stable atmospheric pressure?
- Contact point (?)
- Neurogenic
- Postop
- Anterior ethmoid nerve syndrome
Rhinogenic Pain My Rules of Thumb
Rhinogenic Pain My Rules of Thumb
- Pain attributable to sinus disease should correlate with the presence and location of the disease.
- Suspicion for other causes of facial pain should be sought if: - The pain is out of proportion to the degree of disease - The location of the pain does not correlate to the location of the disease - Pain is intermittent - Pain is brought on by weather changes, allergy, temperature changes, foods, stresss - The sinuses are normal on CT scan
DelGaudioDelGaudio JM, Wise SK, Wise JC. Association of Radiologic Evidenceof Frontal Sinus Disease with the Presence of Frontal Pain.of Frontal Sinus Disease with the Presence of Frontal Pain.JM, Wise SK, Wise JC. Association of Radiologic Evidence AmerAmer J Rhinology 2005;167J Rhinology 2005;167--73 73
DelGaudioDelGaudio JM, Wise SK, Wise JC. Association of Radiologic Evidenceof Frontal Sinus Disease with the Presence of Frontal Pain.of Frontal Sinus Disease with the Presence of Frontal Pain.JM, Wise SK, Wise JC. Association of Radiologic Evidence AmerAmer J Rhinology 2005;167J Rhinology 2005;167--73 73
OpacificationOpacification MildMild-mucosal thickeningmucosal thickening-toto--moderatemoderate (>3 mm diffuse/circumferential(>3 mm diffuse/circumferentialmucosal thickening)mucosal thickening)
Minimal mucosalMinimal mucosal thickeningthickening (<3 mm mucosal(<3 mm mucosal thickening in a dependentthickening in a dependentposition)position) IntermediateIntermediate Most painMost pain Least painLeast pain Non-polyp patients had more pain than polyp patients
What about the patient with “SINUS HEADACHE” and a normal CT scan? i.e. no inflammatory sinusitis
Does this represent a rhinogenic source or migraine headache?
What about the patient with “SINUS HEADACHE” and a normal CT scan? i.e. no inflammatory sinusitis
Does this represent a rhinogenic source or migraine headache?
International Headache Society: Classic Migraine Defined
International Headache Society: Classic Migraine Defined Migraine with Aura
- At least 2 attacks fulfilling criteria (2) - (4) if aura is present
- Headache lasts 4-72 hours
- Headache with 2 or more of the following: unilateral, pulsating, moderate-severe intensity, aggravated by or causing avoidance of routine physical activity
- One of the following occurs during headache: nausea, vomiting,photophobia, phonophobia
- Headache cannot be attributed to another disorder
Headache Classification Subcommittee of the International Headache Society (2004)
EMORY HEALTHCAREEMORY HEALTHCARE
Migraine Headache
United States Incidence
Migraine Headache
United States Incidence
- 18% of females, 6% of males (3:1 ratio)
- Peak incidence 25-55 years of age
- Onset of new cases peaks in adolescence
- Family history
- Inciting factors
- Alcohol, chocolate, stress
“Sinus Headache” is Usually Migraine
“Sinus Headache” is Usually Migraine
- 96% of patients with a diagnosis of sinus headaches met the IHS criteria for migraine HA Cady RK, Schreiber CP. Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology 2002;58 (Suppl 6):S10-S14.
- Barbanti et al (2002)
- Cranial autonomic symptoms frequently present in migraine headache - Nasal congestion, rhinorrhea, lacrimation, eyelid edema
- Causes patients and physicians to attribute symptoms to sinonasal pathology
- Trigeminal innervation
Diagnostic and Therapeutic Dilemma of “Sinus Headache”
Diagnostic and Therapeutic Dilemma of “Sinus Headache”
EMORY HEALTHCAREEMORY HEALTHCARE
Causes of Headache in Patients with Primary Diagnosis of Sinus Headache
Causes of Headache in Patients with Primary Diagnosis of Sinus Headache
- 58 patients with PCP diagnosis of “sinus headache” presenting to Otolaryngologist, then referred to neurologist for evaluation and treatment
- Diagnosis
- 68% migraine HA
- 27% tension HA
- 5% recurrent acute sinusitis
Foroughipour M, et al. Eur Arch Otorhinolaryngol 2011;268:1593-