While the headache may be a primary headache with an unknown cause, it may also be a secondary headache with an obvious cause (rhinogenic headache, neurological diseases, etc.). Rhinogenic headaches may be caused by septal bulges and mucosal contact points in the nasal or paranasal sinus cavities due to middle concha pathologies [8, 9]. In addition, acute sinusitis or exacerbation of chronic sinusitis, which are sinus infections, also occur as common causes of facial and headache [9]. Patients and sometimes primary care physicians may misinterpret face and headache as sinus pathology, and this may lead to wrong treatments [9].
Roozbahany et al., in their study with 65 patients published in 2012, described 11 nasal contact points and nasal anomalies that cause rhinogenic headache. It has been noted that all of these anomalies can be cured by surgery [8]. In our study, as it was investigated whether sinus volumes have a role in the etiology of headache or not, the 11 anomalies and other sinus diseases mentioned above were determined as exclusion criteria from the study.
Our study evaluated the anatomical development and volumes of the sinuses with a three-dimensional formula and shows that volumetric differences may be involved in the etiology of secondary headaches. In the study conducted by Aydemir et al. in 2019 with 200 adult patients with chronic headache and a control group of 99 healthy individuals, it was observed that the total sinus, maxillary sinus, and frontal sinus volumes were found to be significantly smaller in the headache group. In that study, although the sphenoid sinus volume was smaller in the patient group, no significant difference was observed between the patient and control groups. In their study, they concluded that sinus volume may be associated with secondary headache [9].
In a study conducted by Herzallah et al. in 2015 with 28 patients and a control group of 25 patients, only the relationship between total sinus volume and the chronic headache was studied in terms of sinus volume of patient PNSCTs, but they noted that they could not detect a significant relationship [10].
The brain, cranium, most of the dura mater, ependyma, and choroid plexus are insensitive to pain as they lack pain receptors. Headaches; They occur as a result of the involvement of intracranial and extracranial pain-sensitive formations for various reasons. While the pain impulses originating from the supratentorial structures in the skull and the structures in the facial and scalp anterior parts outside the skull are carried to the central nervous system (CNS) by N.Trigeminus and its branches, the pain impulses from the infratentorial formations are carried to the CNS by upper cervical nerves and X-XI. Inflammation, irritation, displacement, stretching, contact with each other, dilatation or invasion of any of these pain-sensitive formations, such as the anatomical structures of the otolaryngology, mucosa and periosteal structures, cause pain. [11]. In our study, we thought that the volumes of the paranasal sinuses, which are located in the anterior and midline of the face and are in contact with important nerve, bone and vascular structures and exposed to air circulation, may have a role in chronic headache.
Our study is the first to study the relationship between headache and sinus volume in the pediatric age group. After excluding other primary and secondary headache causes in pediatric patients with chronic headaches of unknown origins, the paranasal sinus volumes of the patients and children without headache were compared; and the sinus volumes of the group with headache were measured significantly smaller than the children without headaches. These findings contradict some case reports in the literature that assume some rhinogenic headaches are associated with enlarged frontal sinuses [4, 9].
The small number of patients; the limited use of radiological imaging in the pediatric age group, especially CT; and the inability of patients to describe their headaches due to their age might limit our study. The localization of the headache could not be determined due to the pediatric age group.