Sinus headache or migraine? Considerations in making a differential diagnosis

Area of Science:

• Neurology
• Otolaryngology

Background:

• Sinus headache is frequently diagnosed, but specialists consider it rare.
• Many patients diagnosed with sinus headache meet criteria for migraine (International Headache Society).
• This suggests migraine may be misdiagnosed as sinus headache.

Purpose of the Study:

• To explore the relationship between sinus headache and migraine.
• To discuss clinical, epidemiologic, and pathophysiologic connections.
• To inform headache diagnosis and management.

Main Methods:

• Review of clinical and epidemiologic data.
• Analysis of pathophysiologic mechanisms linking nasal symptoms and headache.
• Consideration of International Headache Society diagnostic criteria.

Main Results:

• Nasal symptoms frequently occur with migraine, though not part of diagnostic criteria.
• Parasympathetic activation and neurogenic/immunogenic switching may explain nasal symptoms in migraine.
• Sinus inflammation might trigger migraines.

Conclusions:

• Nasal symptoms with headache do not confirm sinus disease or exclude migraine.
• Headaches with nasal symptoms should prompt consideration of both migraine and sinus conditions.
• Accurate diagnosis is crucial for effective headache management.