I thought I would talk about one of the most common mistakes made in the world of headaches, & it’s especially frequent at this time of year

There are literally thousands of people in the country suffering from bouts of headaches the main features of which are a feeling of pressure and pain in her forehead, under her eyes, and possibly over the cheeks. Often they “feel stuffy,” though without fever, cough, sneezing, or nasal discharge/mucus. Many of them frequently takes pain killers or ‘sinus/congestion ‘ medication which rarely help a great deal.

Most of them, not surprisingly, think they are experiencing sinus headaches (an opinion often shared by their GP). The typical story is, “I get congested, I take antibiotics, and 2 days later I’m better.”
In fact most of these patients are typically experiencing a variant of migraine.

Here’s some data (albeit from the US );

The largest study involved almost 3000 adult patients recruited from a primary care setting with a history of self-reported or physician-diagnosed “sinus” headache who reported at least six headaches during the previous 6 months. On evaluation, 88% of these patients met International Headache Society (HIS) diagnostic criteria for migraine-type headaches. The most common reported symptoms in this group were sinus pressure (84%), sinus pain (82%), and nasal congestion (63%).
The Sinus, Allergy and Migraine Study (SAMS), which recruited patients who believed they had sinus headaches via newspaper advertisements, came to essentially the same conclusion. Approximately 100 patients participated. Final diagnoses, based on IHS criteria, were:
• Migraine with or without aura: 52%;
• Probable migraine: 23%;
• Chronic migraine with medication overuse headache: 11%
• Nonclassifiable headache: 9%.

So how long does it take for a patient initially misdiagnosed with sinusitis to get a correct diagnosis of migraine?

A more recent study recruited 130 adult patients with migraine who were seen in a referral practice. Just over 80% of this cohort had initially been misdiagnosed as having sinusitis, with a mean delay of migraine diagnosis of almost 8 years.
Not surprisingly chronic migraine was more common in this initially misdiagnosed group than in patients appropriately diagnosed at the onset.
More worryingly medication overuse headache was also only in the misdiagnosed group.
One should also not forget the issue of inappropriate use of antibiotics contributing to an increase in antibiotic resistance

So if you are getting frequent bouts of what you think are ‘sinus’ headaches it may well be worth a second opinion from a specialist in headpain.
A good place to start would be here at Epsom & Ewell headache and Migraine Centre to see if in fact you may have a different type of headache for which another type of treatment would be more appropriate/effective.

Wishing everyone a Happy & headache free Christmas.


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