Headache: sino-nasal or migrainous?

ABSTRACT

To outline the clinical features which help to differentiate patients presenting primarily with headache either due to migraine or un-complicated chronic rhino sinusitis. Prospective, comparative study. The study was carried out at the Department of ENT and Head and Neck Surgery, Combined Military Hospital Rawalpindi, a tertiary care hospital. Sept. 2001 to Mar 2003. 60 patients of common migraine [migraine without aura] and 60 patients of uncomplicated acute rhino sinusitis were selected and their headache patterns were compared. Migraine was 3 times more common in young healthy females. The important diagnostic clinical features of common migraine were unilateral cephalic location [76%], pulsatile nature [78%]. Moderate to severe intensity [88%] and association with nausea/ vomiting [58%] and photophobia/ phonophobia [78%]. 10% patients however showed symptoms mimicking sino-nasal disease due to autonomic dysfunction. Patients of acute rhino sinusitis on the other hand had a male predominance with diffuse [75%], mild to moderate headache [83%], nasal mucosal congestion [100%], postnasal dripping [98%], nasal discharge [88%] and nasal obstruction [68%]. Despite the development of rapid, noninvasive radiographic studies, history and physical examination are the comer stones in differentiating headache due to migraine or sino-nasal disease