Sinus migraine: a systematic review and meta-analysis

Introduction: Sinus headache is frequently misdiagnosed, with growing evidence suggesting that many cases may actually be migraine with sinus-like features. Objective: To evaluate the prevalence of migraine among patients initially diagnosed with sinus headache and assess how often migraine is mistaken for sinus-related conditions. Methods: This systematic review and meta-analysis adhered to PRISMA guidelines. Literature searches were performed in Scopus, Medline, PubMed, and Google Scholar using terms such as "sinus headache" and "sinus migraine." Studies were screened based on predefined inclusion and exclusion criteria. A proportional meta-analyses were performed using conducted in R (version 4.3.2), and study quality was assessed using the JBI checklist. Results: Twelve studies involving 4,392 patients were included. Eight studies (Group 1) assessed patients with sinus headache, finding a pooled migraine prevalence of 55% (95% CI: 0.42-0.68), increasing to 59% when probable migraine was included, and 65% when tension-type headache cases were considered. Four studies (Group 2) examined patients with confirmed migraine previously misdiagnosed as sinus headache, with misdiagnosis rates up to 81.5% and diagnosis delays up to 38 years. Female predominance was noted in both groups: 65% (95% CI: 53-77%) in Group 1 and 75% (95% CI: 71-80%) in Group 2. Conclusions: A significant proportion of patients diagnosed with sinus headache were ultimately found to have migraine, with consistently high female predominance-particularly in cases of confirmed migraine misdiagnosis. Enhanced diagnostic vigilance and awareness are needed to reduce misclassification and promote appropriate treatment. (AU)