Abstract text (incl. figure legends and references)

Question: Assessing prevalence of sinonasal symptoms in migraine.

Methods: The Migraine in Poland study is a nation-wide cross-sectional online survey, conducted from August 2021 to June 2022. Survey protocol included questions assessing diagnostic criteria for migraine without aura (MwoA) according to International Classification of Headache Disorders-3, rhinosinusitis (European Position on Rhinosinusitis and Nasal Polyps 2020 – EPOS2020) and sinonasal/cranial autonomic symptoms (CAS) in relation to headache attacks.

Results: Among 1679 subjects meeting criteria for MwoA 602 (35.85%) of participants confirmed having at least one episode of self-described "sinus headache" in the last year (n=520 - 30.97% in the 3 months before the study). At least one nasal symptom was accompanying headache in 1004 (59.8%) respondents. During headache attacks, 315 (18.76%) subjects met symptomatic criteria for rhinosinusitis diagnosis according to EPOS2020. These symptoms were accompanied by other (non-nasal) CAS in n=251 (42.40%). Osmophobia was reported by 66.29% MwoA subjects. Hyposmia was present during headache attacks in 10.84%, with the majority of these respondents reporting co-existent osmophobia.

Conclusions: Sinonasal symptoms commonly occur in MwoA subjects, with 1/5 having symptoms indicating rhinosinusitis and many more reporting at least one rhinologic symptom during headache. Osmophobia and hyposmia are not mutually exclusive in MwoA, which limits their value in differentiating between rhinosinusitis and migraine. A comprehensive, multidisciplinary workup still remains the baseline in discerning between migraine and rhinosinusits.