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Sinus Headaches May Acutally Be Migraine

Throbbing and tenderness in your nose, cheeks and/or eyebrows seem to be clear indicators of a sinus headache. Most likely they aren’t. 90% of what patients think are sinus headaches are actually untreated migraines.

[Headache specialist Eric] Eross and colleagues advertised a free evaluation to people suffering from “sinus headaches.” They signed up the first 100 people, and gave them a rigorous 1.5-hour evaluation. It turned out 90 of the 100 patients were really suffering from migraines.

Sinus headaches do exist, but they are much rarer than people believe.

If you have an active sinus infection, your head hurts. Typical symptoms include fever, swollen lymph nodes, and a green or yellow nasal discharge. But most people who think they have sinus headaches don’t have these symptoms — just pain high in their cheeks. They likely have migraines, Eross says.

Following the study, about half the participants who thought they had sinus headaches became Dr. Eross’s patients. Most of them improved dramatically with migraine treatment.

Sinus headache was one of my early self-diagnoses. I can’t tell you how many allergists, ENTs and ENT surgeons I saw. I underwent numerous tests and scans and tried meds and allergy shots, but nothing showed that I had sinus headaches. That didn’t stop me from having nasal surgery for my headaches, which was completely ineffective.

My migraines don’t fit the symptoms of what most people think of as migraine: I didn’t have a visual aura, one-sided pain, nausea or sensitivity to light. Turns out that this describes “classic migraine” (or migraine with aura) which about 40% of people with migraine have symptoms of. Much more common is migraine without aura, often called “common migraine.”

Because of this, getting the right diagnosis was difficult for me. My experience makes me want to tell everyone who has “sinus headaches” that they could have another kind of headache disorder. Since this is my blog, I will. Please consider that your headaches aren’t sinus-related.

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Explaining What Chronic Daily Headache and Migraine Are Like

Explaining to my family, friends and employers that my migraines are debilitating has been challenging. There are many misconceptions about headache disorders and migraine, so people don’t understand the difference between an occasional headache and CDH or migraine.

The best way I’ve found to let those around me know the seriousness of this illness is to let them see me in the throes of a migraine (which is not an easy feat). If the people in your life are willing to talk about your pain, there are many good resources to explain the severity of the illness.

The best resource I have found is a book called Chronic Pain and the Family, which I reviewed on Blogcritics. (If you decide to buy the book, I’d appreciate it if you went to Amazon through the link from my blog rather than Blogcritics — it helps pay for The Daily Headache.)

There are other good resources that won’t cost you anything, like these significant facts about migraine:

  • Between 28 million and 35 million (depending on which estimate you look at) Americans have migraines
  • Of these migraine sufferers, 91 percent aren’t able to function normally during a migraine
  • An estimated $17 billion in health care and lost labor costs result annually from adults suffering from migraines

The National Headache Foundation has terrific information on how headache affects a sufferer’s life. This fact sheet (PDF) describes migraine and its suspected mechanics. It even recommends a children’s book that explains the disease to kids. ACHE also has good information.

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American Council for Headache Education’s New Website

Wondering how migraine and tension-type headache differ? Or what the common migraine treatments are? The American Council for Headache Education (aka ACHE) has a new website that will answer these questions and more.

Particularly good stuff:

All headache organization and educational sites have similar information. How it’s presented is the difference. ACHE’s articles are brief, but don’t skimp on details. The vast amount of information is narrowed to key topics, so you’re not overwhelmed. Articles aren’t bogged down with confusing jargon and are well-written.

I was shocked that ACHE links to Wikipedia’s migraine page. Wikipedia is a wonderful pop culture and travel reference, but am I’m wary of it for serious topics. The migraine page used to be full of errors and misleading information. At 1:03 pm PST on July 22, the page is quite good. Just know it is ever-changing and that being wrong doesn’t preclude someone from editing it.

ACHE’s site is primarily focused on migraine, which is the case
with a lot of headache sites (including mine). Perhaps it’s because
migraine is so prevalent and underdiagnosed. The articles are helpful even if you aren’t a migraineur. You might find — like I did — that your headaches that aren’t migraines actually are.

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News From the American Headache Society’s Annual Meeting

If I wait to write about news from the American Headache Society’s annual meeting in depth, it may never get posted. So here are the headlines and links to AHS’s press releases.

Insurance, Cost Issues Prevent People From Treating Migraines

Insurance companies often limit the number of migraine pills people are allowed each month, so many sufferers forgo taking the medication when they need it because they’re afraid of running out. . . .

That translates into many people unnecessarily living with potentially disabling migraine pain and suffering poorer quality of life than they would have if they took their medication when needed.

Killer Headaches Play Starring Role On The Silver Screen, But Don’t Reflect The Real World

Horrendous headaches make fabulous movie plot devices and are often the result of such dramatic situations as a tumor, toxic poisoning or device implanted in the brain, rather than something as banal as a migraine. . . .

“Yes, we know movies are fantasy, but they also are very effective at formulating public opinion. So many people already worry about what causes their headaches and this is not a good way to reassure them.”

In the real world, the vast majority of head pain is “primary,” meaning the cause typically is migraine, tension or cluster headache. Unlike in the movies, headaches are far less often due to “secondary” causes, such as head trauma, stroke, aneurysms, infection or tumors and never – at least to the knowledge of medical science – by a brain-control device.

Three-Item Questionnaire Helps School Nurses Identify Students With Migraines

A simple questionnaire can help school nurses identify students who get migraine headaches, a problem that affects one in 10 children and teens but often goes undiagnosed. The three-question Pediatric and Adolescent
Migraine Screen (PAMS) is an accurate measurement of migraine that easily can be used by school nurses. . . .

“Although PAMS is not a final diagnostic tool, using it to screen and possibly refer children for appropriate diagnosis of migraine can greatly improve these kids’ quality of life, including their ability to participate in school, sports and other extracurricular activities,” said Dr. Kabbouche.

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Chiari Malformation & Headache

One of the uncommon causes of headache is called Chiari malformation. Also referred to as Arnold-Chiari, it’s a condition where brain tissue protrudes into the spinal canal. It happens when part of the skull is extra small or misshapen and presses on the brain, forcing it downward.

As with much of the scary stuff I write about, very few people’s headaches are caused by this malformation. So don’t panic! Chiari is detected by an MRI and headache is only one of the many possible symptoms.

Anna Roberts, a medical student in the UK, was recently diagnosed with and had surgery to correct her Chiari malformation. She describes having brain surgery while a medical student — a situation where she has enough information to be scared, but not enough to know what’s really happening.

Mayo Clinic has an easy-to-read explanation of Chiari, it’s symptoms and treatments. You can also learn more from NIH‘s Chiari fact sheet.

[via Kevin MD]