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Migraine may act like sinus headache. (Sumatriptan Effective).

HONOLULU -- The overwhelming majority of "sinus" headaches are actually migraine headaches, according to a large clinical trial that Dr. Curtis P. Schreiber reported by the annual meeting of the American Academy of Neurology.

The 3,038 patients in the study, who had six or more self described or physician-diagnosed "sinus" headaches during the prior 6 months, were seen at 453 mostly primary care sites in the United States. The study excluded patients with a prior diagnosis of migraine, prior use of triptans, sinus headache with fever or purulent discharge, or radiographic evidence of sinus infection within the past 6 months, said Dr. Schreiber of the Headache Care Center, Springfield, Mo.

The use of International Headache Society criteria showed that 80% of the 3,038 patients had migraine with or without aura, 8% had migrainous headaches, 8% had tension-type headache, and 4% had other headache types, he said.

Along with standard migraine symptoms, the 2,424 patients who were diagnosed with migraine often reported "sinus" headache symptoms: 84% reported sinus pressure, 82% reported sinus pain, 63% reported nasal congestion, 40% reported rhinorrhea, 38% reported watery eyes, and 27% reported itchy nose.

Sumatriptan seems to be an effective treatment for such "sinus" headaches, based on findings from the next, openlabel phase of the trial. In this phase of the trial, 1,354 patients with migraine treated up to three of their usual "sinus" headaches with 50 mg sumatriptan. Afterward, 68% of these patients reported relief at 2 hours, and 83% reported relief at 4 hours. Patients expressed satisfaction with sumatriptan in 76% of attacks.

A smaller, placebo-controlled trial led by Dr. Gary Ishkanian of Mt. Vernon (N.Y.) Hospital yielded similar results. GlaxoSmithKline sponsored both studies.

In Dr. Ishkanian's study, 215 patients who had self-described or physician-diagnosed "sinus" headache and who were found to have migraine with or without aura were randomized to treat their next typical "sinus" headache with 50 mg of sumatriptan or placebo.

Headache relief was significantly greater with sumatripran than with placebo at 2 hours (69% vs. 43%) and at 4 hours (76% vs. 49%). Sumatriptan also was significantly more effective in alleviating phonophobia and photophobia than placebo at both 2 hours and 4 hours.
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Author:Finn, Robert
Publication:Internal Medicine News
Date:May 15, 2003
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