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

Laryngoscope. 2008 Dec;118(12):2235-9. doi: 10.1097/MLG.0b013e318182f81d.


Objective: To determine the response rate to triptans in alleviating "sinus headache" in patients with endoscopy- and computed tomography (CT)-negative sinus examinations.

Study design: Prospective clinical trial.

Methods: Patients who presented to a tertiary care center Otolaryngology Department with primary complaints of facial pain, pressure, or headache localized over the area of the sinuses, and a self- or physician-diagnosis of "sinus headache" were enrolled. Patients underwent directed history, physical examination, rigid nasal endoscopy, a sinus CT scan, and completed a headache questionnaire. Those patients that had negative findings were treated empirically with triptans. Patients completed a headache diary for each headache, using a visual analogue scale to rate the headache before and after triptan use. Response was considered as significant improvement (greater than 50% reduction of pain), partial (25-50% reduction), and no response.

Results: Fifty-four patients were enrolled. Thirty-eight (69%) completed follow-up, 63% were women. The mean age was 41 years (23-70). Thirty-one patients (82%) had significant reduction of headache pain with triptan use. Thirty-five patients (92%) had a significant reduction in headache pain in response to migraine-directed therapy. Seventeen patients (31%) withdrew or failed to follow-up, often reluctant to accept a diagnosis of migraine.

Conclusions: This study demonstrated that the demographics of patients with self-described "sinus headaches" who did not have findings of sinusitis on endoscopy and CT scan closely reflected the demographics of patients afflicted with migraines. It also showed that 82% of these patients had a significant response to empiric treatment for sinus headaches with triptans. These findings support that "sinus headaches" may represent migraines, and response to triptans may aid in diagnosis.

MeSH terms

  • Adult
  • Aged
  • Chronic Disease
  • Diagnosis, Differential
  • Empiricism
  • Endoscopy
  • Female
  • Follow-Up Studies
  • Headache / drug therapy*
  • Headache / etiology*
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / etiology*
  • Pain Measurement
  • Prospective Studies
  • Pyrrolidines / adverse effects
  • Pyrrolidines / therapeutic use*
  • Referral and Consultation
  • Serotonin Receptor Agonists / adverse effects
  • Serotonin Receptor Agonists / therapeutic use*
  • Sinusitis / diagnosis*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tryptamines / adverse effects
  • Tryptamines / therapeutic use*


  • Pyrrolidines
  • Serotonin Receptor Agonists
  • Tryptamines
  • eletriptan