Facial/sinus pain or pressure and migraine: exploratory findings from the HEADS registry
Bibliographic record
Abstract
Background Rhinosinusitis (RS) is a leading reason for antibiotic prescriptions but treatment satisfaction is low. Misdiagnosis may contribute to poor outcomes, as migraine—often underrecognized—can mimic RS symptoms, with studies showing overlap between RS and migraine diagnoses. Our aims were to explore the demographics and clinical features of facial pain or pressure (FPP), its relationship with migraine and RS, and distinguish symptoms between these overlapping conditions. Methods The HEADS Registry, a web-based survey, targets adults with head and/or neck symptoms. Participants who answered “yes” (FPP+) or “no” (FPP−) to experiencing recurrent facial or sinus pain/pressure were included in this analysis. The ID Migraine screening tool was used to classify participants as ID Migraine+ or ID Migraine−. Demographics, symptoms, disability, history of allergies, sinusitis, and antibiotic use were compared between 1) FPP+ and FPP− groups, 2) FPP+/ ID Migraine+ and FPP+/ID Migraine−, and 3) FPP+/ID Migraine− and FPP−/ID Migraine+ subgroups. Continuous variables were compared using independent samples t-test or Mann–Whitney U, and categorical variables were compared using chi-square or Fisher's exact test. Results The FPP+ group (n = 598) was younger, more often female, and reported higher rates of nasal, vestibular, and otologic symptoms compared to the FPP− group (n = 146). They also had more severe headaches, migraine-associated symptoms, and higher ID Migraine screening rates. The FPP+ group reported greater daily symptom interference, and more allergies, sinus infections, and antibiotic use. Those who screened positive for migraine (FPP+/ID Migraine+, n = 438) had more severe symptoms, greater disability, and more frequent forehead/eye pain. FPP+/ID Migraine− (n = 48) participants were more likely to report nasal symptoms, allergies, and sinus infections, while FPP−/ID Migraine+ (n = 85) participants reported more disabling headaches. Conclusion In this exploratory analysis, FPP was strongly associated with headache, including migraine, as well as allergies, rhinosinusitis, and antibiotic use. The low reported effectiveness of antibiotics suggests potential misdiagnosis. Findings that migraine, plus autonomic, vestibular, otologic symptoms are associated with FPP, highlight the need to expand the differential diagnosis beyond infectious causes. These insights, along with ongoing registry improvements, will support efforts to refine diagnostic accuracy and optimize treatment strategies for neurologic, otologic, and rhinologic conditions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".