title: Underestimation of Rhinogenic Causes in Patients Presenting to the Emergency Department with Acute Headache.
abstract: OBJECTIVE
  Differential diagnosis is essential, since secondary headache due to paranasal sinus lesions are similar in headache characteristics to primary headache. However, since patients visiting the emergency department due to acute severe headache are primarily treated by neurologists, paranasal sinuses lesions and anatomical variations of the nasal cavity causing the headache are commonly overlooked because of the clinician's lack of knowledge about rhinosinugenic headache. This study investigated the prevalence of paranasal sinus lesions and anatomical variations that may cause secondary headaches in patients who were diagnosed as primary headache and treated by neurologists in the emergency room.
  
  
  METHODS
  A retrospective study was done involving 1235 patients who visited the emergency department from January 2008 to December 2012 and who were diagnosed with primary headache. From the axial view of brain computed tomography, examination of sinusitis, mucosal contact points, concha bullosa, isolated sphenoid lesion, and osteoma were done, and location and morphology was analyzed.
  
  
  METHODS
  Three hundred fifty-five of 1235 (28.7%) patients had sinusitis, mucosal contact points, concha bullosa, isolated sphenoid lesion, and osteoma as possible causes for secondary headaches.
  
  
  CONCLUSIONS
  Differential diagnosis of primary headaches requires knowledge of paranasal sinus lesions including rhinosinusitis or anatomical variations. Also, interdisciplinary evaluation of acute headache presenting to the emergency room is necessary for accurate diagnosis and proper management.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine.
authors.forename: Jae-Heon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine.
authors.forename: Hyun-Jik
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine.
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Hong
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine.
authors.forename: Kyung-Soo
authors.initials: KS
authors.lastname: Kim
mesh_terms: D059787:Acute Pain / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000150:complications* / Q000453:epidemiology; D010254:Paranasal Sinus Diseases / Q000150:complications* / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult