Schreiber Curtis P, Hutchinson Susan, Webster Christopher J, Ames Michael, Richardson Mary S, Powers Connie
Headache Care Center, Springfield, MO, USA.
Arch Intern Med. 2004 Sep 13;164(16):1769-72. doi: 10.1001/archinte.164.16.1769.
Symptoms referable to the sinus area are frequently reported during migraine attacks, but are not recognized in diagnostic criteria. Underrecognition of migraine may be partly attributed to a variable clinical presentation, and migraines with "sinus" symptoms contribute to this problem. This study was conducted to determine the prevalence of migraine-type headache (International Headache Society [IHS]-defined migraine without aura [IHS 1.1], migraine with aura [IHS 1.2], or migrainous disorder [IHS 1.7]) in patients with a history of self-described or physician-diagnosed "sinus" headache.
During a clinic visit, patients with a history of "sinus" headache, no previous diagnosis of migraine, and no evidence of infection were assigned an IHS headache diagnosis on the basis of headache histories and reported symptoms.
A total of 2991 patients were screened. The majority (88%) of these patients with a history of self-described or physician-diagnosed "sinus" headache were diagnosed at the screening visit as fulfilling IHS migraine criteria (80% of patients) or migrainous criteria (8% of patients). The most common symptoms referable to the sinus area reported by patients at screening were sinus pressure (84%), sinus pain (82%), and nasal congestion (63%).
In this study, 88% of patients with a history of "sinus" headache were determined to have migraine-type headache. In patients with recurrent headaches without fever or purulent discharge, the presence of sinus-area symptoms may be part of the migraine process. Migraine should be included in the differential diagnosis of these patients.
在偏头痛发作期间，经常会出现鼻窦区域相关的症状，但这些症状在诊断标准中未被认可。偏头痛未被充分认识可能部分归因于临床表现的多样性，而伴有“鼻窦”症状的偏头痛加剧了这一问题。本研究旨在确定有自述或医生诊断为“鼻窦”头痛病史的患者中偏头痛型头痛（国际头痛协会[IHS]定义的无先兆偏头痛[IHS 1.1]、有先兆偏头痛[IHS 1.2]或偏头痛性疾病[IHS 1.7]）的患病率。
在门诊就诊时，根据头痛病史和报告的症状，对有“鼻窦”头痛病史、既往无偏头痛诊断且无感染证据的患者进行IHS头痛诊断。
共筛查了2991名患者。这些有自述或医生诊断为“鼻窦”头痛病史的患者中，大多数（88%）在筛查就诊时被诊断为符合IHS偏头痛标准（80%的患者）或偏头痛性标准（8%的患者）。患者在筛查时报告的最常见的鼻窦区域相关症状为鼻窦压痛（84%）、鼻窦疼痛（82%）和鼻塞（63%）。
在本研究中，88%有“鼻窦”头痛病史的患者被确定患有偏头痛型头痛。在无发热或脓性分泌物的复发性头痛患者中，鼻窦区域症状的出现可能是偏头痛过程的一部分。偏头痛应纳入这些患者的鉴别诊断。
