The scan may fail to identify a patient with true sinus pain caused by nasal congestion or isolated minimal osteomeatal complex obstruction, especially if it is intermittent. These patients can have barometric sinus pain with normal or nearly normal radiographic images. Rhinomanometry and acoustic rhinometry, while demonstrating some clinical usefulness in the assessment of nasal patency, cannot detect disease within the osteomeatal complex, and therefore cannot routinely be used to determine whether sinonasal disease is present. Other parameters are needed to help differentiate between sinonasal pain and migraine or vascular headaches. One such differentiating indicator is vision change.
Visual aura are well described and known to be associated with migraine headache.
Alterations in vision occur much less frequently with headaches of sinonasal origin, and the characteristics of the vision changes are quite different. It is possible that vision changes may be of benefit in differentiating between these frequently occurring yet widely disparate causes. The features of migraine aura are characteristic and clearly described throughout the literature. The aura may be positive, with bright lights or shapes within the visual field, or negative, occurring as dark holes or visual blackouts. There may be straight or jagged lines that obscure the vision.