Sinus Headaches: Otolaryngology Treatment or Neurology Referral: Analysis of Efficacy and Cost‐Effectiveness of Migraine Treatment

Objectives: Evaluate the efficacy and cost‐effectiveness of empiric treatment of sinus headaches/migraines initiated by an otolaryngologist versus referral to a neurologist for treatment. Methods: Retrospective chart review from 1998 to 2013 of patients with ICD‐9 codes for headache or atypical facial pain at an academic medical center. Comparison of cost of workup and treatment initiated by an otolaryngologist was compared with that of patients referred to neurology. Length of delay in treatment was also calculated for patients referred to neurology. Results: Of 797 patients reviewed, 57 patients were primarily treated by otolaryngology, and 104 patients were referred to neurology for treatment. Success of patients treated by otolaryngology was 78.9% versus 81.8% for neurology‐treated patients (P =. 77). The average wait for an appointment with a neurologist specializing in headache was 57.9 days. Forty‐two patients had a history of chronic rhinosinusitis, with 18 in the otolaryngology‐treated group and 24 in the neurology referral group (P =. 25). Cost analysis showed that there was a significant increase in health care costs when patients were referred to neurology for diagnosis and treatment, with the referred patients accruing higher health care costs in the form of office visits, medications, and imaging techniques. Conclusions: Recognition of sinus headaches as migraines by the otolaryngologist and initiation of treatment allows for earlier improvement of symptoms, improved quality of life, and decreased health care costs, with equal success rates to that of patients treated by neurology.