Sinus headache: a clinical conundrum

The concept of sinus disease as a common cause of headache is deeply ingrained in the American public, but there is little evidence to support the sinuses as a common cause of disabling headache. On the other hand, a body of evidence supports the concept that migraine can present with facial pain and nasal symptoms such as congestion and rhinorrhea. In clinical studies nearly 90% of participants with self-diagnosed or physician-diagnosed sinus headache met criteria for IHS migraine-type headache and responded to triptan interventions in a manner similar to that witnessed in migraine. Consequently it is likely that most individuals seeking medical attention for sinus headache are, in fact, experiencing migraine. Nasal pathologic conditions, however, can also cause sinus headache. In general. other symptoms in addition to headache are also present, but there is clear symptom overlap among migraine, rhinosinusitis, and other nasal passage/sinus pathologic conditions, and further research is needed.