title: Causes of headache in patients with a primary diagnosis of sinus headache.
abstract: Headache is a common occurrence among the general population. Although the pain could be a symptom of acute sinusitis, chronic sinusitis is not considered as a usual cause of headache. In addition, autonomic-related symptoms in the sinonasal region may be associated with vascular pain. Confusion regarding these symptoms could lead to an incorrect diagnosis of sinusitis. A prospective cross-sectional study was conducted at two tertiary referral centers with residency programs in otorhinolaryngology, head and neck surgery and neurology. The study included 58 patients with a diagnosis of "sinus headache" made by a primary care physician. Exclusion criteria were as follows: previous diagnosis of migraine or tension-type headache; evidence of sinus infection during the past 6 months; and the presence of mucopurulent secretions. After comprehensive otorhinolaryngologic and neurologic evaluation, appropriate treatment was started according to the final diagnosis and the patient was assessed monthly for 6 months. The final diagnoses were migraine, tension-type headache and chronic sinusitis with recurrent acute episodes in 68, 27 and 5% of the patients, respectively. Recurrent antibiotic therapy was received by 73% of patients with tension-type headache and 66% with migraine. Sinus endoscopy was performed in 26% of the patients. Therapeutic nasal septoplasty was performed in 16% of the patients with a final diagnosis of migraine, and 13% with tension-type headache. Many patients with self-described or primary care physician labeled "sinus headache" have no sinonasal abnormalities. Instead, most of them meet the IHS criteria for migraine or tension-type headache.
authors.affiliation: Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Foroughipour
authors.forename: Shahriar Mohammad Reza
authors.initials: SM
authors.lastname: Sharifian
authors.forename: Ali
authors.initials: A
authors.lastname: Shoeibi
authors.forename: Nazanin
authors.initials: N
authors.lastname: Ebdali Barabad
authors.forename: Mehdi
authors.initials: M
authors.lastname: Bakhshaee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses; D011446:Prospective Studies; D012852:Sinusitis / Q000150:complications* / Q000175:diagnosis; D018781:Tension-Type Headache / Q000150:complications* / Q000175:diagnosis; D013997:Time Factors; D055815:Young Adult