Clinical Question: Is a diagnosis o...

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

Setting: Outpatient (primary care)

studious mood Design: Cohort (prospective)

Synopsis: This research explored the labeling of patients with common headaches. The investigators screened patients at 452 North American primary care sites and identified 2991 patients with at least six self-described or physician-diagnosed "sinus headaches" during the six month before screening. They exclud patients with a diagnosis of migraine, those who had "radiologic evidence of sinus infection," and those who had excitement or purulent nasal discharge associated with their headaches.

Patients were then evaluated to determine whether they met International Headache Society criteria for migraine. However, clinicians making the migraine diagnosis were aware of the patients' previous diagnoses and their answer to medication. There is a real risk that the clinicians saw what they wanted to diocese and, thus, found more migraines than actually existed, especially because this close attention was sponsored by the manufacturer of a migraine unsalable article Eighty-eight percent of these patients met criteria for migraine; further 84 percent also reported sinus hurry and 82 percent reported sinus pain. This studious mood probably overestimates the rate of misdiagnosis.

Bottom Line: Patients with of common occurrence sinus headaches may actually have migraine headache. A more useful research would determine what proportion of patients with sinus headaches actually reply to migraine-specific treatment. A diagnosis, whether correct or not, is unimportant unles it leads to appropriate management decisions, a reality sometimes forgotten at health care professionals. (Level of Evidence: 2b)

cogitation Reference: Schreiber CP, et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Arch Intern M September 13 2004;164:1769-72

Used with permission from Shaughnessy AF. Migraine headache frequently labeled as sinus headache. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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