Friday September 28, 2012

What are sinus headaches?

They are almost always migraine headaches.

The United States is the only country in the world where patients get "sinus headaches." That’s because such headaches are almost always not actually related to the sinuses. These headaches are usually migraine headaches, which often respond well to migraine prescription and over-the-counter medications.

During my residency training in otolaryngology (ear, nose and throat surgery, or ENT), Dr. Robert Kaniecki, the chief of the Headache Division at the University of Pittsburgh, explained that many migraine sufferers have been trained by television advertising to think of their symptoms, including a headache, as a sinus problem. Images of glowing red facial pain centers, strained fingers pointing to the cheeks, nose and eyes, and similar techniques have been used for decades by over-the-counter drug advertisers.

Decades ago, apparently, there was an incorrect association in the public mind between migraines and mental illness, and hence "migraine headaches" acquired a stigma. Nobody wanted to be known as a migraine sufferer. Marketers pitched their medications for relief of the so-called sinus headache instead. But, no other country has such a disease! Physicians who trained in other countries are often quizzical when they encounter the term in the U.S.

I myself did not realize I was a migraine headache sufferer until I had almost completed medical school.


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I knew that I had recurrent terrible headaches that could rob me of a day’s enjoyment. I just didn’t know that they were migraines, and that they were easily treatable and controllable.

A simple set of three screening questions has been developed for primary care doctors and other health professionals called the ID Migraine Screener.

The questions are:

1. Has a headache limited your activities for a day or more in the last three months?

2. Are you nauseated or sick to your stomach when you have a headache?

3. Does light bother you when you have a headache?

According to a study in 2003 of more than 400 patients at dozens of doctors’ offices, 93 percent of patients who answer yes to two of these three questions were subsequently diagnosed later as migraine sufferers, by physicians who are headache experts and saw them subsequently. If you answer yes to two of these three questions, you almost certainly have migraines, and not sinus headaches.

Of course, there are other types of headaches, and, rarely, the sinuses have something to do with them. One of the key points about migraines, though, is that they are recurrent - they go away, but they keep coming back. That’s why the first of the three questions asks about your medium-term headache history. If a sinus is diseased, by contrast, the diseased state doesn’t usually go away by itself - the problem stays, without improving, until it’s treated.

The word sinus means empty cavity or space. The sinuses located around the nose, termed the paranasal sinuses, help humidify and warm the air we breathe in, among other functions. There is one large sinus in each cheekbone (under the eyes) - the maxillary sinuses. There are sinuses between the eyes - the ethmoid sinuses. There are sinuses in most (but not all) people above the bony rims of the eye sockets - the frontal sinuses. And there are sinuses that are behind your nose, essentially in the very middle of your head, called the sphenoid sinuses.

Many patients come to see me complaining of "sinusitis." When I listen to their actual symptoms, without first choosing a diagnostic label, they often sound like they are suffering from migraines. Of course I examine the inside of their noses thoroughly (with a miniature fiber-optic scope) for signs of infection or inflammation, but more often than not, everything looks fine. After explaining that I think they may have migraines, I give them a trial of an anti-migraine medication. If that doesn’t relieve their symptoms, it may be time for me to search further, for example with a CT scan of their sinuses. But many of them are cured by the anti-migraine medications.

I have a great deal of sympathy for migraine sufferers, being one myself. I know that a bad migraine can ruin your day, or even several days. Knowing how to treat and manage migraines, though, is a great relief for patients. A sometimes incapacitating pain becomes a relatively easily controlled, minor inconvenience.

The paranasal sinuses rarely hurt. If you think you may have sinus problems, but your primary symptom is recurrent headaches, take the three-question quiz above. If you answer yes to two of the three questions, talk to your primary care doctor about a trial of an anti-migraine medication. It might just change your life. If you’re still convinced after the quiz and medication trial that there’s something wrong inside your nose, I’ll be very happy to take a look and see what we find.

William Wood, MD is a board-certified Otolaryngologist practicing at Southern Vermont Ear, Nose & Throat Associates, a member of the BMH Physician Group. He can be reached at 802-257-8355.