Why are migraines misdiagnosed as sinus headache?
Migraineurs and some physicians misdiagnose headaches as “sinus” because the pain occurs in the face or forehead, a change in weather is a common trigger, and the presence of cranial autonomic symptoms seems like sinus symptoms.
Cranial autonomic symptoms in migraine are caused by parasympathetic activation of the sphenopalatine ganglion, which innervates the tear ducts and sinuses.
At least one symptom is present in 56% of migraineurs, usually bilaterally, but is not usually present during each attack.
The most common cranial autonomic symptoms are forehead/facial sweating, conjunctival injection and/or lacrimation, and nasal congestion and/or rhinorrhea.
Sources
Lipton RB, Bigal ME, Diamond M, et al.: Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 68:343-349, 2007.
