why doctors misdiagnose migraines as sinus headaches?

December 10, 2020

Why doctors misdiagnose migraines as sinus headaches? 

According to the National Ambulatory Care Survey, headaches are among the top 20 most common chief complaints encountered in an outpatient setting, as well as the 5th leading cause of emergency room admission in the United States. This high frequency of occurrence definitely warrants high precision in making a medical diagnosis, alarmingly there seems to be a widespread confusion in the medical field.

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Despite being a common diagnosis by so many physicians, the disease entity called Sinus Headache is rarely acknowledged by experts in the field of otolaryngology and neurology. The reason behind this aversion to the term sinus headache is because it is not the main disease entity by itself; instead, it is part of the group of symptoms caused by a condition called rhinosinusitis. The confusion starts with an increase in reports of sinus headaches despite the relative rarity of the diagnosis rhinosinusitis.  In the study done by Headache Care Center, it was stated that most self-diagnosed and physician diagnosed reports of sinus headaches do not meet the criteria for rhinosinusitis but were actually migraine headaches that were misdiagnosed.   

When seeing it from the perspective of a patient who suffers pain in the facial area, it would be understandable why they confuse sinus headaches with migraines. Both can be extremely painful and can alter the sense of smell and in rare instances vision. Another possible reason why such mix up occurs can be attributed to advertising which pushes the sale of sinus medications.  Another factor to consider is that there are reports from the  Headache Care Center that most of the diagnoses of sinus headaches were made by physicians lacking skills in both routine and endoscopic examination of the nose, possibly contributing to the rate of misdiagnosis.  

The extent of the wrong diagnosis is truly serious. According to the International Headache Society, 90% of self- or provider-diagnosed sinus headaches have been found to be unrelated to any sinus conditions and instead, often satisfy the criteria for migraines.  Researchers of the study are pushing for more extensive information dissemination among physicians. They encourage the use of a migraine screening tool which focuses on symptoms like nausea, photophobia, and headache-related disability before considering a diagnosis of rhinosinusitis. This 3-item ID Migraine Screener has proven to be effective   93.3%  of the time in screening for migraine headaches according to the Journal of Headache and Pain.  Another study supporting these findings suggests treating those suspected migraine cases with Triptan, a drug for a migraine, to help rule out the condition.  

The key to effective treatment is definitely an accurate diagnosis. The researchers of the studies are urging physicians not to rely solely on patient reports and outmoded protocols so that the true patient diagnosis may be addressed.  

The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. 


Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. 


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Sinus headache or migraine? Considerations in making a differential diagnosis. 


New thoughts on sinus headache. 


The validation of ID migraine™ screener in neurology outpatient clinics in Turkey 


Treatment of sinus headache as migraine: the diagnostic utility of triptans.