son of of interest to some
by John at 6/14/2004 01:31:00 PM
We all get migraine headaches. OK, maybe we don't all get them, but it turns out that about 28 million Americans do. Headache researchers have discovered that 90% of "sinus headaches" are really mis-diagnosed migraine headaches. That is, it may not really be a sinus headache unless it is accompanied by a sinus infection (symptoms: yucky colored mucus and fever) - otherwise, pain due to "pressure" behind the eyes is probably a migraine.
For a few years now, I have been able to identify an oncoming migraine headache (extreme pain and nausea) by noticing that my head felt congested (e.g. blocked sinuses and slight pain in the sinus area). What this new research says is that these are just symptoms of a migraine, and so I have been identifying oncoming migraines by noticing that I had a migraine. Pointless! Nonetheless, for me, taking sinus medication (pseudoephedrine or similar) tends to delay or prevent the onset of the really bad part of the migraine by eliminating the feeling of being stuffed up.
Furthermore, over the years I have developed the non-scientific understanding that my post-adolescence migraines are associated with changes in air pressure (specifically, drops in pressure). However, other, more careful, researchers have demonstrated that the onset of migraines is not a useful predictor of weather. To be clear, 51% of migraine sufferers are sensitive to weather changes, it's just that the sufferers aren't aware of which weather factor correlates with their migraine. For the curious, the results show:
For a few years now, I have been able to identify an oncoming migraine headache (extreme pain and nausea) by noticing that my head felt congested (e.g. blocked sinuses and slight pain in the sinus area). What this new research says is that these are just symptoms of a migraine, and so I have been identifying oncoming migraines by noticing that I had a migraine. Pointless! Nonetheless, for me, taking sinus medication (pseudoephedrine or similar) tends to delay or prevent the onset of the really bad part of the migraine by eliminating the feeling of being stuffed up.
Furthermore, over the years I have developed the non-scientific understanding that my post-adolescence migraines are associated with changes in air pressure (specifically, drops in pressure). However, other, more careful, researchers have demonstrated that the onset of migraines is not a useful predictor of weather. To be clear, 51% of migraine sufferers are sensitive to weather changes, it's just that the sufferers aren't aware of which weather factor correlates with their migraine. For the curious, the results show:
Temperature or humidity changes sparked pain in 34 percent of sufferers, while 14 percent were hit when a weather pattern changed and 13 percent when it was a pressure change. About 10 percent had their pain triggered by more than one type of weather change.
At least there is evidence that it isn't all in my head. (Ow! It hurt just to write that joke.)
I wonder about some researcher bias with the first study listed; 90% of sinus headaches are mis-diagnosed migraines? I concur that migraines can present in a multitude of ways and that they are probably underdiagnosed. But the presentation listed; mucopurulent discharge, fever and sinus tenderness to percussion (my addition) is specific for bacterial sinusitis (which need antibiotics), Sinusitis can also be viral, much more common (treated with time, fluids, and decongestants); and lacks the mucopurulent discharge, fever is notable low grade (less than 101) and general malaise accompanies the sinus pressure/pain, sore throat and cough are also frequently present; this infection is often simply referred to as a URI (upper respiratory infection). Allergic rhinitis can also cause sinus headaches and is very common.
A panel of neurologists and headache experts mighty have loaded opinions about the true nature of sinus headaches since migraines are in their reealm of treatment and sinus headaches are usually treated by internists, family practioners or if refractory, ENTs. But I haven't read the study myself, just the synopsis linked by John and I will withhold final judgement
Did some more research and discussion with colleagues, consensus is that many cases of sinus headache may well be misdiagnosed migraines and that bacterial sinusitis is probably over diagnosed. But viral sinusitis and allergic rhinitis are extremely common and can cause headaches, though probably less severe headaches than migraines or acute bacterial sinusitis. I suppose time and history really help, chronic bacterial sinusitis rarely causes headaches; the infection is lying pretty low and the sinus inflammation is not as severe, so if a patient diagnosed with acute bacterial sinusitis kept having headaches then I would think of migraines. And if the headache involved other symptoms, nausea, photophobia, phonophobia, aura, and was unilateral, I would lean away from acute bacterial sinusitis, viral sinusitis or allergic rhinits. Though acute bacterial sinusitis of the three listed is often unilateral (but not always).
Found this on Up To Date (a website that offers meta-analysis of current literature and studies, updated every 4-6 months), I really love Up To Date, pay site though.
PRIMARY (FACIAL) HEADACHE — Migraine, cluster headache, and other "headaches" (such as chronic paroxysmal hemicrania) can present mainly in the face. Many patients diagnosed with "sinus headaches" in fact have migraine. Careful attention to details of the history and examination should clarify the diagnosis. Questions revealing a family history, trigger factors, or the presence of an aura point toward migraine as the etiology.
Similarly, cluster headache and other short lasting headaches may present with pain principally in the face rather than periorbitally or retroorbitally. The clarification of the duration of the episodes, along with any associated autonomic features (ptosis, rhinorrhea, lacrimation) is diagnostically helpful.
Jabs and jolts syndrome (idiopathic stabbing headache) can occur in isolation or as part of another headache condition, such as migraine. The pain is typically of very brief duration and of lancinating quality. Like trigeminal neuralgia, it may occur in volleys [33]. Jabs and jolts often respond to indomethacin, while trigeminal neuralgia preferentially responds to carbamazepine. (See "Jabs and jolts syndrome" below).
Before declaring a diagnosis of dental or sinus disease as the etiology of facial pain, positive evidence must be established, as discussed below. Many patients with primary headache syndromes have been subjected to needless dental or surgical procedures because of the location of their pain, not because of truly local disease.
Thanks for sharing the more comprehensive medical information.
When confronted by a scientific article in mainstream media, I often wonder whether the reporter actually got the information correct, because their own understanding of the issue may not be very great. This is not to de-legitimize science or medical reporting. Of course, a science reporter may be quite competent in a particular field without having much more than a basic understanding of other fields, just like most scientists.
Lastly, like many people, I enjoy cataloging and describing my aches and pains to anyone who shows the slightest interest. Thanks for obliging me! You can expect more in the future.
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