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Sino-Nasal Anatomical Variations in Rhinogenic Headache Pathogenesis

A Case–Control Clinical Study

Sollini, Giacomo MD; Mazzola, Francesco MD; Iandelli, Andrea MD; Carobbio, Andrea MD; Barbieri, Andrea MD; Mora, Renzo MD; Peretti, Giorgio MD

doi: 10.1097/SCS.0000000000005239
Clinical Study: PDF Only

Rhinogenic headache (RH) is a widespread pain syndrome but its pathogenesis and treatment are still unclear. Some authors recognize a correlation between RH and mucosal contact points or some other sinonasal anatomical variations. The authors conducted a retrospective case–control study to analyze the correlation between radiological findings and clinical symptoms.

One hundred-nineteen adults with Para-Nasal Sinuses Computed Tomography (PNS-CT) scans were included: 64 patients who have originally undergone PNS-CT scan as part of rhinogenic headache workup (Group A), and 55 controls in whom PNS-CT scans were obtained for other purposes (Group B). All subjects were asked to report their symptoms using a headache scoring system. PNS-CT scans of all subjects were analyzed for presence of mucosal contact points, middle turbinate concha bullosa (MTCB) and frontoethmoidal cells.

The most common anatomical abnormality found in our series was MTCB, reported in 60.9% of patients in Group A and 41.8% of those in Group B. A statistically significant prevalence was found in Group A compared to Group B regarding the presence of MTCB (P = 0.037) and Type II (P = 0.016) and Type III (P = 0.039) frontoethmoidal cells. No statistically significant difference (P >0.05) was found between Group A and Group B regarding the presence of mucosal contact points at each site.

Multiple anatomical variations in nasal and paranasal sinuses may cause a rhinogenic headache with different characteristics. Some of these, such as concha bullosa of middle turbinate or type II and III Kuhn cells, have shown a significant association with rhinogenic headache. No statistically significant association was found between presence of headache and mucosal contact points and type I and IV frontal cells. These findings can be very helpful for the surgeons that want to deal with the treatment of RH.

Department of Otorhinolaryngology—Head and Neck Surgery, University of Genoa, Genova (GE), Italy.

Address correspondence and reprint requests to Giacomo Sollini, MD, University of Genoa, Department of Otorhinolaryngology—Head and Neck Surgery, San Martino Hospital, Largo Rosanna Benzi, 10, 16132 Genova GE; E-mail:

Received 28 June, 2018

Accepted 24 November, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.