What clinical clues differentiate migraine from sinus headaches?
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Evidence-based answer: Patients with sinus headaches have thick nasal discharge, fever, chills, sweats, or abnormally malodorous breath (SOR: B, cross-sectional study). The 5 symptoms that are most predictive of migraine are: pulsatile quality, duration of 4 to 72 hours, unilateral location, nausea or vomiting, and disabling intensity (SOR: B, retrospective cohort). As the number of these symptoms increases, so too, does the likelihood that the patient has a migraine (SOR: B, systematic review of retrospective cohort studies). Most patients diagnosed with sinus headache actually have a migraine headache (SOR: B, 2 cross-sectional studies).
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