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Editor's Correspondence |

The Demise of the Sinus Headache Is Premature—Reply

Curtis P. Schreiber, MD; Christopher J. Webster, BS
Arch Intern Med. 2005;165(8):954-955. doi:10.1001/archinte.165.8.954-b.
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Dr Chester points out a valid question, and we would like to clarify that the results of the SUMMIT study1 do not discount the validity of acute sinus infection as a cause of headache, nor do they suggest that clinicians should not thoroughly evaluate their patients before considering a differential diagnosis of the headache disorder.

The SUMMIT study was designed to evaluate the headache diagnosis of patients with episodic recurrent “sinus” headache. It required subjects to have had at least 6 attacks in the 6 months preceding enrollment in the study. The headache frequency criteria alone should have eliminated patients with headaches secondary to infections. Symptoms of obvious infection (fever and purulent discharge) in association with headache as well as a history of abnormal sinus imaging studies were exclusionary criteria, precluding entry into the study. So, as Dr Chester points out, the SUMMIT study does not determine the percentage of patients with “sinus” headache that have acute infection as the cause. While not addressed in SUMMIT, the frequency of sinus infection as the cause of “sinus” headache has been addressed in another study by Eross and Dodick.2 One hundred consecutive patients with “sinus” headache of any cause (infectious symptoms were not exclusionary) were evaluated. It was found that 3 of 100 patients had a sinus infection to account for the headache, while 86% had a migraine-type disorder causing “sinus” headache.

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