Headache attributed to rhinosinusitis in pediatric patients: clinical insights and diagnostic implications

Background: Headache attributed to rhinosinusitis (HRS) is relatively uncommon in pediatric patients and frequently misdiagnosed as a primary headache disorder. This study was conducted to identify the clinical characteristics of HRS [bacterial rhinosinusitis (BRS) and non-BRS] and determine the appropriate treatment of headaches. Methods: The medical records of 1,777 individuals who exhibited headache and underwent neuroimaging studies at two institutions between January 2014 and December 2023 were retrospectively reviewed. Results: Of the 1,777 patients, 203 (11.3%) were diagnosed with HRS (47 with BRS, 90 with non-BRS, and 66 unclassified). The proportion of male patients was significantly higher in the BRS group (76.6% vs. 57.8%, P=0.02). A comparison of clinical characteristics between the BRS and non-BRS groups revealed significantly higher frequencies of respiratory symptoms in the BRS group (P<0.001) and blurred vision in the non-BRS group (P=0.03). The BRS group demonstrated the involvement of a greater number of sinuses and more frequent use of therapies, including antibiotics and antihistamines (P<0.001 for both). Conclusions: Recognizing the clinical characteristics of BRS and non-BRS is important for the accurate diagnosis and optimal management of pain in pediatric patients with headache, as alleviating headaches significantly could affect both the quality of life and academic performance.