title: The impact of comorbid migraine on quality-of-life outcomes after endoscopic sinus surgery.
abstract: OBJECTIVE
  Chronic rhinosinusitis (CRS) and migraine are common entities with overlapping symptomatology, yet little research exists that investigates the intersection of the two. This study seeks to investigate whether patients with CRS-with and without a migraine history-experience comparable quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS).
  
  
  METHODS
  Retrospective analysis of a prospective cohort.
  
  
  METHODS
  An adult population (n = 229) with medically refractory CRS was prospectively evaluated following ESS using disease-specific QOL surveys: the Rhinosinusitis Disability Index (RSDI), the Chronic Sinusitis Survey (CSS), and the Sinonasal Outcome Test-22 (SNOT-22). History of comorbid migraine was identified (n = 46), and preoperative and postoperative QOL was compared to patients without migraine (n = 183).
  
  
  RESULTS
  Patients migraine and CRS were more likely to be female (P = 0.023); experience allergies (P = 0.024), fibromyalgia (P = 0.009), and depression (P = 0.010); and be less likely to have nasal polyposis (P = 0.003). Objective measures of disease (endoscopy and computed tomography scores) were significantly lower in patients with migraine (P = 0.027 and P = 0.002, respectively), yet these patients scored lower on baseline RSDI and SNOT-22 scores (P = 0.025 and P = 0.019, respectively). QOL in both patients with and without migraine improved significantly after ESS (P ≤ 0.003) and by comparable magnitudes (P ≥ 0.062).
  
  
  CONCLUSIONS
  Patients with comorbid migraine and CRS are more likely to have less severe evidence of disease and worse preoperative baseline QOL scores. This may imply that comorbid migraine disorder, in the setting of CRS, compels these patients to seek surgical management earlier in the disease process. Regardless, ESS provides comparable improvement for both patients with and without comorbid migraine.
authors.affiliation: Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.
authors.forename: Adam S
authors.initials: AS
authors.lastname: DeConde
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications*; D011788:Quality of Life; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications* / Q000601:surgery*; D012852:Sinusitis / Q000150:complications* / Q000601:surgery*
keywords: Sinusitis; comorbidity; migraine disorders; outcome assessment; quality of life