Sinus Migraine: Diagnostic Criteria and Management Algorithm for a New Clinical Entity

PROGRAM DESCRIPTION: Sinus migraine is a new term for a neurogenic condition in which patients experience pain, pressure, or discomfort of the midface. Common associated symptoms include nasal congestion, ear pressure, and allodynia of the face. The pathophysiology is thought to be related to autonomic and sensory dysfunction of the trigeminal distribution. Because it is not well-characterized, millions of patients with sinus migraine are misdiagnosed with sinusitis each year and undergo unnecessary treatment with antibiotics and sinus surgery, especially if they have incidental mucosal thickening on CT imaging. Based on our prior research, it is likely that over half of healthcare expenditure for chronic sinusitis is for outpatient visits in which antibiotics are unnecessarily prescribed. In order to address this, we propose diagnostic criteria as well as a cost-efficient treatment algorithm for sinus migraine. We will also discuss our latest research findings from a 500+ patient registry as well as our qualitative and quantitative work developing a validated screening tool for sinus migraine.

OUTCOME OBJECTIVE 1: Discuss the pathophysiology and clinical presentation of sinus migraine

OUTCOME OBJECTIVE 2: Analyze the latest research on ways to differentiate sinus migraine from sinusitis

OUTCOME OBJECTIVE 3: Propose a management algorithm for sinus migraine

BACKGROUND STATEMENT: We need to help otolaryngologists diagnose and manage sinus migraine, as these patients will continue to receive unnecessary antibiotics and sinonasal procedures (ie surgery, balloon dilation, and most recently posterior nasal nerve ablation).

Comprehensive Otolaryngology Track Statement : Migraine is a common clinical entity seen by comprehensive otolaryngologists, yet lacks diagnostic and treatment guidelines. In particular, sinus migraine is likely more common than chronic rhinosinusitis in the comprehensive ENT clinic.