SECONDARY HEADACHES

Objectives: Objectives were 1) to determine whether a correlation exists between facial pain or headache and sinus disease severity by computed tomography (CT) scan in patients with rhinosinusitis and 2) to compare disease severity and pain perception in two geographically diverse North American patient populations. Study Design: Prospective patient questionnaire before CT scan of the paranasal sinuses. Methods: Patients with refractory rhinosinusitis were recruited at the University of Texas Medical Branch ( Galveston, TX) and the University of Alberta (Edmonton, Alberta, Canada). Before CT scanning, patients completed a pain questionnaire. All scans were interpreted by one neuroradiologist and were scored using the Lund‐McKay,  Harvard, and Kennedy staging systems for rhinosinusitis. Results: Fifty‐one patients completed questionnaires (27 were Canadian). There was no correlation between pain severity and disease severity reflected by any of the three staging systems used ( P > .05). The mean pain score for the U.S. patients was 7.3, and for Canadian patients, 5.2. The mean CT scores for U.S. versus Canadian patients were as follows: Lund‐McKay, 2.6 versus 6.6; Harvard, 0.7 versus 1.0; and Kennedy, 1.4 versus 2.2. The Canadian patients had more severe disease on CT scan (Lund‐McKay, P < or = .001; Harvard, P < or = .005; and Kennedy, P < or = .007) while reporting less severe pain ( P < or = .004). CONCLUSIONS: There was no correlation between pain severity and disease severity by sinus CT scan as graded by the Lund‐McKay, Harvard, or Kennedy staging system. Facial pain and headache, although frequent complaints of patients with rhinosinusitis, are not useful predictors of sinus disease severity. There appears to be a difference in pain perception between the two North American populations. Comments: The relationship between sinus disease and headache is one of the hot topics in the United States today. Several studies suggest that when patients self‐diagnose “sinus headaches,” the headaches usually meet IHS criteria for migraine (Cady RK, Schreiber CP. Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology. 2003;58(9 suppl 6):S10‐S14). Headache is not a primary feature of acute sinusitis. SJTDoes this make functional imaging redundant if the results do not correlate with severity? Nice to see that the Canadians are as tough as the Americans, despite the French influence! DSM