Patients often believe they have a sinus headache when in fact the headache frequently has another cause. The diagnosis of sinus headache can be confusing because of signs and symptoms in common with migraine. Although not as common a diagnosis as migraine, sinus headache and the associated treatments can be found extensively in references on the Internet.
Key points
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Symptoms of migraine headache and sinus headache can be similar.
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Both can occur with nasal congestion and facial pain, and can worsen during weather change.
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Sinus headache and the associated treatments can be found extensively in references on the Internet.
“Doctor, I have a sinus headache!” These words are heard frequently by physicians, especially otolaryngologists, headache specialists, neurologists, primary care physicians, pediatricians, and emergency room physicians. Although patients frequently believe they have a sinus problem, sinus headaches are not as common as individuals might think.
Some studies suggest that up to 90% of sinus headaches are actually migraines. The confusion occurs partly because migraine headache involves activation of the trigeminal nerves that innervate both the sinus region and the meninges surrounding the brain. As a result, the site from which the pain originates is difficult to accurately determine. Additionally, nasal congestion can be a common feature of migraine headaches because of the autonomic nerve stimulation that can also cause tearing (lacrimation) and a runny nose (rhinorrhea). A study found that patients with sinus headaches responded to triptan migraine medications, but stated dissatisfaction with their treatment when they were treated with decongestants or antibiotics. Treating these common symptoms without having the correct diagnosis can create overuse and misuse of resources, unnecessary surgeries, and unhappy patients. This issue addresses the differences and subtleties of sinus headaches.
To better understand the overall frequency of diagnosis, treatment pathways, and procedures and costs associated with sinus headaches, the Truven MarketScan (formerly Thomson Reuters) Commercial Claims and Encounters Database (Version 183), the largest United States–based claims database, was queried. MarketScan includes inpatient, outpatient, and prescription histories for all patients. For 2012 alone, MarketScan contains information on more than 50 million lives, with medical data available over multiple continuous years. This database is therefore extremely valuable, in that it can be used to track large patient cohorts longitudinally over time.
Because no specific International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code exists for sinus headache, ICD-9 code 784.0 for headache (without further mention of cause or type) was used. This code is not specific to sinus headaches, but it provided the best match of all currently available diagnostic codes because it includes all headaches that are neither migraine/tension headache nor other forms of definable headache. Using this preliminary diagnosis code, a series of queries were built ( Fig. 1 ) to understand how many of these headache diagnoses truly end up being caused by sinus disease. Specifically, all patients with a 784.0 diagnosis in the outpatient setting in January 2011 were identified. Of those, patients who also had a concurrent head computed tomography (CT) scan within ±30 days of the 784.0 diagnosis were further queried ( Table 1 provides a list of current procedural terminology used to identify head CTs), because these patients possibly underwent CT scan for sinus disease. The percentage of those patients with a 784.0 headache diagnosis and a sinus CT who were actually diagnosed with acute sinusitis, chronic sinusitis, or polyposis within 3 months of their CT was then analyzed. To do so, this subset of patients with an ICD-9 diagnosis code of 461.X (acute sinusitis), 473.X (chronic sinusitis), or 471.X (polyposis) were queried (the “X” means that all ICD-9 with the first 3 digits as shown here and any possible 4th digit were included).
| 70496 | CT angiography, head |
| 70540 | MRI orbit/face/neck without dye |
| 70542 | MRI orbit/face/neck with dye |
| 70543 | MRI orbit/face/neck with and without dye |
| 70544 | MR angiography head without dye |
| 70545 | MR angiography head with dye |
| 70546 | MR angiography head with and without dye |
| 70450 | CT head/brain without dye |
| 70460 | CT head/brain with dye |
| 70470 | CT head/brain with and without dye |
| 70480 | CT orbit/ear/fossa without dye |
| 70481 | CT orbit/ear/fossa with dye |
| 70482 | CT orbit/ear/fossa with and without dye |
| 70486 | CT maxillofacial without dye |
| 70487 | CT maxillofacial with dye |
| 70488 | CT maxillofacial with and without dye |
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