The impact of comorbid migraine on quality-of-life outcomes after endoscopic sinus surgery

Objectives/Hypothesis Chronic rhinosinusitis (CRS) and migraine are common entities with overlapping symptomatology, yet little research exists that investigates the intersection of the two. This study seeks to investigate whether patients with CRS - with and without a migraine history - experience comparable quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS). Study Design Retrospective analysis of a prospective cohort. Methods An adult population (n=229) with medically refractory CRS was prospectively evaluated following ESS using disease-specific QOL surveys: the Rhinosinusitis Disability Index (RSDI), the Chronic Sinusitis Survey (CSS), and the Sinonasal Outcome Test-22 (SNOT-22). History of comorbid migraine was identified (n=46), and preoperative and postoperative QOL was compared to patients without migraine (n=183). Results Patients migraine and CRS were more likely to be female (P=0.023); experience allergies (P=0.024), fibromyalgia (P=0.009), and depression (P=0.010); and be less likely to have nasal polyposis (P=0.003). Objective measures of disease (endoscopy and computed tomography scores) were significantly lower in patients with migraine (P=0.027 and P=0.002, respectively), yet these patients scored lower on baseline RSDI and SNOT-22 scores (P=0.025 and P=0.019, respectively). QOL in both patients with and without migraine improved significantly after ESS (P≤0.003) and by comparable magnitudes (P≥0.062). Conclusion Patients with comorbid migraine and CRS are more likely to have less severe evidence of disease and worse preoperative baseline QOL scores. This may imply that comorbid migraine disorder, in the setting of CRS, compels these patients to seek surgical management earlier in the disease process. Regardless, ESS provides comparable improvement for both patients with and without comorbid migraine.