Child with Sinus Headache?

My child has a horrible sinus headache – they’re flushed and sweating, they’re congested … their eyes are watering … and they have a runny nose.  What should I do?  Antibiotics?  Nasal spray?

Not so fast.  There is increasing evidence that your child may actually have migraine.  And if you’re getting these symptoms, you may too.

One of the most common and notorious misdiagnosis is mistaking migraine for sinusitis.  A study completed this year further confirms that – even in children – these symptoms could be tricking doctors into giving the wrong treatment.  And the wrong treatment could do more harm than good.

This study out of the University of California was recently published in the journal Neurology.  It included paediatric and adolescent patients who had actually been diagnosed with migraine.  Most of them had more than one “cranial autonomic symptom”.  It didn’t matter if migraine was chronic, if there was aura or not, or what age the patient was.

What are cranial autonomic symptoms?  These are symptoms of the head that are not controlled by the patient.  They could include things like:

• Congestion
• Runny nose
• Watery eye
• Flushing/sweating
• Puffy eyelid, or droopy eyelid
• A sensation of fullness in the ear

This study suggests that these may not be unusual migraine symptoms – but very common ones.

Now the symptoms tended to be one-sided, but that’s not enough to help doctors correctly diagnose migraine.  Patients and doctors need to be more careful about tracking symptoms, being aware of the patient’s medical history, and asking more questions – maybe even doing more tests.

In addition, these symptoms could indicate other headache disorders, such as short-lasting unilateral neuralgiform headache attacks.

The wrong treatment could have a lasting impact – a longer period of time without improvement, and even harm from medications and antibiotics that was unnecessary.  Because migraine attacks tend to go away in three days or less, many parents think that the nasal spray or antibiotic “worked”.  In reality, the attack went away on its own (and probably could have gone away sooner with the proper treatment).

Headache is much more common in migraine than in sinusitis.  Think twice before giving your child medications and especially antibiotics (which likely aren’t needed in sinusitis either).  Get a second opinion, and watch symptoms carefully.