Migraine headache often labeled as sinus headache

Journal of Family Practice, Dec, 2004

Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Arch Intern Med 2004; 164:1769-1772.

* CLINICAL QUESTION

Is a diagnosis of migraine more appropriate for patients who have headaches attributed to sinus symptoms?

* BOTTOM LINE

Patients with frequent sinus headaches may actually have migraine. A more useful study would determine what proportion of patients with sinus headaches actually respond to migraine-specific treatment. A diagnosis, whether correct or not, is unimportant unless it leads to appropriate management decisions, a reality sometimes forgotten by health care providers. (LOE=2b)

* STUDY DESIGN

Cohort (prospective)

* SETTING

Outpatient (primary care)

* SYNOPSIS

A diagnosis is a label placed on a collection of signs, symptoms, and findings used to guide management decisions. This study explored the labeling of patients with frequent headaches. The investigators screened patients at 452 North American primary care sites and identified 2991 with at least 6 self-described or physician-diagnosed "sinus headaches" during the 6 months before screening. They excluded patients with a diagnosis of migraine and those who had "radiologic evidence of sinus infection" (whatever that is), fever, or purulent nasal discharge associated with their headaches. These patients were then evaluated to determine whether they met International Headache Society criteria for migraine.

A big limitation to this study is revealed at this point: Clinicians making the migraine diagnosis were aware of the patients' previous diagnoses and their response to medication. There is a real risk that the clinicians saw what they wanted to see, and thus found many more migraines than there actually were, especially since this study was sponsored by a manufacturer of a migraine drug. And so: 88% of these patients met criteria for migraine. Yet 84% also reported sinus pressure and 82% reported sinus pain. This study probably overestimates the rate of misdiagnosis.