New thoughts on sinus headache.

Sinus headache is not a recognized entity by allergy, otolaryngology, or neurological organizations. Headache is a minor feature in the diagnosis of acute rhinosinusitis and is not validated as a symptom in chronic sinusitis. Sinus headaches are self-diagnosed due to weather triggers, bilateral and frontomaxillary location, and the presence of vasomotor signs and symptoms, all of which can accompany the migraine. Over 90% of self-diagnosed and doctor-diagnosed sinus headaches meet the International Headache Society criteria for migraines, and those migraines misdiagnosed as sinus headaches respond to sumatriptan better than placebo because migraines respond to triptans. Sinus headaches are usually severely disabling migraines, misdiagnosed and mistreated, with 61% of patients receiving antibiotic prescriptions for noninfectious causes, thus failing the patients and, in addition, contributing to a serious public health problem.