CRS vs. migraine: which is the culprit in most headaches?
Reviewed by Joanna Stephens

‘Sinus headache’ is a common diagnosis according to patients and primary care physicians, but relatively infrequent in the eyes of otolaryngologists. This study examines 104 patients with a primary headache syndrome (PHS) and 130 patients with CRS, looking at SNOT-22 scores, Lund-Mackay CT scores, Lund-Kennedy endoscopy scores and patient demographics. The authors divide the SNOT-22 into four major domains of Nasal, Aural/Facial, Sleep and Emotional. Interestingly, patients with PHS had similar SNOT-22 scores to those with CRS, but generally had higher scores in the Aural/Facial and Sleep domains. CRS patients unsurprisingly had higher Nasal scores. This is interesting, particularly in the current times, when we have had to rely on telephone consultations due to the COVID-19 pandemic. Utilising a SNOT-22 and telephone assessment may overestimate the prevalence of CRS, and we must remember the importance of an endoscopic evaluation of the nose in its predictive value for correct diagnosis of CRS. As the authors state, “if patient symptoms seem to be rated out of proportion to the nasendoscopy and imaging findings, the diagnosis of PHS should be suspected. Presence of PHS, however, does not exclude sinonasal pathology, and a complete otolaryngology exam should be completed on every patient who presents with the complaint of “sinus headache”.

Symptoms and Clinical Findings in Primary Headache Syndrome versus Chronic Rhinosinusitis.
Sharbel DD, Owen HC, Yelverton JC, et al.
AM J RHINOL ALLERGY
2021;35(3):308-14.