Sinus Headache Is Rare.

November 17, 2009 by dean · Leave a Comment 

Sinus Headache is rare

Sinus Headache is rare

Why is it that ‘sinus headache’ continues to be diagnosed so frequently. Whilst true sinus headache does exist most authorities agree that it is rare.

I have commented on this previously, so please refer to the ‘Home Page’ and key in the search term ‘Sinus Headache’.

Cheers

Dean

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

The Enormous Amount of Research

September 6, 2009 by dean · Leave a Comment 

Despite the enormous amount of research into the various forms of headache and migraine their cause remains a mystery.

To help you, the headache or migraine sufferer know the source of you pain as precisely as possible, latest research into headache and migraine is summarised on this website.

This includes research into migraine, tension-type headache, cluster headache, paroxysmal headache, hemicrania continua, post-traumatic headache, menstrual migraine, sinus headache and cervicogenic (neck) headache.

Cheers

Dean

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Migraine, Sinus Headache and the ‘Triptans’ – There’s More!

August 9, 2009 by dean · Leave a Comment 

Further to my comment earlier, the ‘triptans’ have been shown to be useful in differentiating migraine from sinus headache.

As in past studies patients with a self-diagnosis or physician-diagnosis of ‘sinus’ headache were assessed. An overwhelming 82% had a significant reduction in their headache symptoms.

This extraordinary response provides further (not that any more is required!) evidence that the significant majority of ‘sinus’ headaches are migraine and that the ‘triptans’ aid diagnosis.

Don’t want to take a ‘triptan’? That’s OK because a skilled examination of your upper neck will quickly tell you that it isn’t ‘sinus’ headache, but an unrecognised cervicogenic (neck) headache.

Cheers

Dean

(Kari E, DelGaudio JM. treatment of sinus headache as migraine: the diagnostic utility of triptans. Larygoscope 2008 Dec;118(12):2235-9)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Migraine, Sinusitis and Recurring Headache in Children

August 8, 2009 by dean · Leave a Comment 

Examine the upper necks of children before sinus surgery

Examine the upper necks of children before sinus surgery

Given what we know about ‘sinus’ headache in adults, it is not surprising that a recent survey has concluded that children with recurrent headaches are misdiagnosed as sinus headache and receive unnecessary Xrays and sinus treatment.

Of 214 patients, approximately 40% of patients with migraine and 60% with tension-type headache had been misdiagnosed as ‘sinus’ headache; treatment of sinuses had no effect in 60%; and of those 53% patients who had had Xrays, 50% were normal.

Examination of the upper neck in children with recurrent (and ‘suspected’ sinus) headache is as important as it is in adults. This is relatively inexpensive and does not involve radiation ….

Cheers

Dean

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

(Senbil N et al. Sinusitis in children and adolescents with chronic or recurrent headache: a case-controlled study. J Headache Pain 2008 Feb;9(1):33-6)

The Triptans, Migraine and Sinus Headache

August 7, 2009 by dean · Leave a Comment 

It has been claimed that the effectiveness of the triptans in someone experiencing facial pain does not exclude a diagnosis of ‘sinus’ headache because it has been shown that the ‘triptans’ do relieve the pain of sinusitis. Whilst this is true (because abnormal information from a diseased, infected sinus will sensitise the brainstem and the ‘triptans’ desensitise the brainstem), the relief from pain will not continue once the effect of the ‘triptans’ has worn off if the facial pain were coming from an infectious condition – the triptans are not an antibiotic.

But why take a ‘triptan’ when an examination of the neck will confirm in most cases, in my clinical experience of over 13000 hours, a neck disorder as the sensitising source in the headache and migraine process?

Cheers

Dean

(Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28

Kari E, DelGaudio JM. Treatment of sinus headache as migraine: the diagnostic utility of triptans. Laryngoscope 2008 Dec;118(12) :2235-9

Kim H. The characteristics of sinus headache resembling the primary headaches. Nippon Rinsho 2005 Oct;63(10):1771-6)

Migraine and Sinus Headache

August 6, 2009 by dean · Leave a Comment 

Sinus Pain

Sinus Pain

Of 2991 patients with a self-described or physician diagnosis of ‘sinus’ headache, an overwhelming 88% were diagnosed as migraine!

Clearly, as the researchers concluded, migraine (not to mention tension-type headache) should be considered and indeed the most likely cause of facial pain.

Cheers

Dean

(Schreiber CP et al. Prevalence of migraine in patients with a history of self reported or physician-diagnosed “sinus” headache. Arch Intern Med 2004 Sep 13;164(16):1769-72)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Chronic Sinusitis is Uncommon

August 4, 2009 by dean · Leave a Comment 

Neck disorders sensitise the brainstem

Neck disorders sensitise the brainstem

Over 90% of diagnosed sinus headaches present in the same way as migraine headache and that given that the majority of ‘sinus’ headaches respond to the ‘triptans’, they can be classified as migraine. Why then are 61% of patients given antibiotics for a non-infectious condition?!

It is more responsible to identify the source of the sensitisation and …. neck disorders sensitise the brainstem! All that is required is for a competent headache practitioner to examine your neck.

Cheers

Dean

(Cady RK, Schreiber CP. Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 2004 Apr;37(2):267-88

Goldhammer L. Second cervical root neurofibroma and ipsilateral migraine headache. Cephalalgia 1993; 13:132

Jansen J, Markakis E, Rama B, Hildebrandt J. Hemicranial attacks or permanent hemicrania – a sequel of upper cervical root compression. Cephalalgia 1989; 9:123-30

Tepper SJ. New thoughts on sinus headache. Allergy Asthma Proc 2004 Mar-Apr;25(2):95-96 ;

Ward TN, Levine M. Headache caused by a spinal cord stimulator in the upper cervical spine. Headache 2000; 40:689-91)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Headache, Migraine and Facial Surgery

July 28, 2009 by dean · Leave a Comment 

In survey of 75 patients who had undergone surgery for facial pain all had ongoing symptoms. The researchers concluded that the causes of symptoms were migraine, cluster headache, paroxysmal hemicrania and tension headache, and that sinus surgery in the large majority of patients presenting with facial pain should avoid surgery; that all surgeons when assessing facial pain should be aware of non-sinuonasal diagnoses.

An enlightened ENT Specialist refers patients to me to determine if facial pain is referred from disorders of the upper neck – and more often it is! Temporary reproduction and easing of familiar facial pain when upper neck structures are gently stressed confirms this in the large majority of patients with facial pain.

Cheers

Dean

(Jones NS, Cooney TR. Facial pain and sinonasal surgery. Rhinology 2003 Dec;41(4):193-200)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

How to Avoid Unnecessary Sinus Surgery for Your Headache or Migraine

July 6, 2009 by dean · Leave a Comment 

True sinus headache is rare.

Clinical studies have demonstrated that nearly 90 per cent of patients with a diagnosis of ‘sinus’ headache have migraine or tension headache and therefore it is not surprising that recent research has shown that the ‘triptans’, medication developed specifically for migraine and which has been shown to be effective in tension headache, also relieved ‘sinus’ headache – if this happens then clearly it is not a sinus headache!

However we also know that Cervicogenic (neck-related) headache is often misdiagnosed as migraine or tension headache and that the ‘triptans’ are effective in cervicogenic headache (that is why there is a misdiagnosis!). This suggests that the mechanisms of migraine, tension headache and neck-related headache are similar and that a neck disorder is capable of referring pain into the facial region, raising the possibility that ‘sinus’ headache may actually be referred pain from a neck disorder.

Indeed my experience is (and a significant body of research demonstrates) that facial pain and pressure is often a referred pain from a neck disorder. A very aware Ear, Nose and Throat surgeon sends me patients with ‘sinus’ headache to determine if it is referred from the neck before embarking on surgery, thus avoiding unnecessary and the not insignificant surgery!

Cheers

Dean

(Cady RK, Schreiber CP. Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 2004 Apr;37(2):267-88

Kari E, DelGaudio JM. treatment of sinus headache as migraine: the diagnostic utility of triptans. Larygoscope 2008 Dec;118(12) :2235-9

Pavese N, Bibbiani F, Nuti A, Bonuccelli U. Sumatriptan in cervicogenic headache. Proceedings European Headache Federation 2nd International Conference 1994; Abstract 131

Tepper SJ. New thoughts on sinus headache. Allergy Asthma Proc 2004 Mar-Apr;25(2):95-96 ;

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.