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Clinical and Multivariate Predictors of Headaches Attributed to Rhinosinusitis in Pediatric Patients: A Comparative
Seung Beom Han1,2, Eu Gene Park1,3, Ji Yoon Han1,4
1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Insights
Pediatric headache attributed to rhinosinusitis (HRS) is often misdiagnosed. Key predictors include young age, nasal/auditory symptoms, and family history, aiding accurate diagnosis.
Area of Science:
- Pediatric Neurology
- Otolaryngology
- Medical Diagnostics
Background:
- Headache attributed to rhinosinusitis (HRS) is uncommon in children and frequently misdiagnosed as migraine or tension-type headache (TTH).
- Diagnostic challenges arise from overlapping symptoms, incidental sinus findings on neuroimaging, and communication difficulties in younger patients.
- Misdiagnosis leads to inappropriate treatment and delayed identification of underlying rhinosinusitis.
Purpose of the Study:
- To identify distinct clinical predictors differentiating pediatric HRS from migraine and TTH.
- To improve diagnostic accuracy and reduce misclassification of pediatric headaches.
- To guide appropriate management and avoid unnecessary investigations.
Main Methods:
- Retrospective analysis of 3065 pediatric patients (<19 years) with headache and ≥1 year follow-up.
- Classification of headaches using International Classification of Headache Disorders (ICHD-3) criteria.
- Diagnosis of HRS required radiologic sinus pathology and symptom improvement with targeted therapy; symptom profiling used PCA and k-means clustering; logistic regression identified predictors.
Main Results:
- Of 3065 patients, 4.5% were diagnosed with HRS, with nearly one-third initially misclassified.
- HRS patients were younger (median 9 years), more often male, and included a higher proportion of preschool-aged children compared to migraine/TTH.
- Independent predictors for HRS included shorter headache duration, higher intensity, nasal symptoms, hearing impairment, allergic rhinitis, and family history of HRS (all p < 0.001).
Conclusions:
- Pediatric HRS exhibits distinct predictors: young age, acute severe headache, sinonasal and auditory symptoms, allergic history, and family history.
- These predictors, alongside otolaryngologic assessment, can enhance diagnostic accuracy for pediatric HRS.
- Improved diagnostic strategies may reduce misclassification, unnecessary neuroimaging, and inappropriate treatments for pediatric headache patients.
Background/Objectives:
Headache attributed to rhinosinusitis (HRS) is uncommon in children but often misdiagnosed as migraine or tension-type headache (TTH). Overlapping phenotypes, incidental sinus findings on neuroimaging, and limited communication in younger patients complicate diagnosis and lead to inappropriate treatment.
Methods:
We retrospectively analyzed 3065 pediatric patients (<19 years) presenting with headache at two tertiary neurology clinics (2014-2023) with ≥1 year follow-up. Headaches were classified by ICHD-3 criteria. HRS diagnosis required radiologic sinus pathology and ≥50% improvement within 72 h of antibiotic or decongestant therapy. Demographic, clinical, neuroimaging, and family history data were collected. Symptom profiling used principal component analysis (PCA) and k-means clustering; multivariate logistic regression identified independent predictors.
Results:
Of 3065 patients, 32.7% had migraines, 15.5% TTH, and 4.5% HRS. Nearly one-third of HRS cases were initially misclassified. Compared with migraine and TTH, HRS patients were younger (median 9 years), more often male, and enriched in preschool age. Independent predictors included shorter duration (<1 h; OR 0.62), higher intensity (OR 2.165), nasal symptoms (OR 9.836), hearing impairment (OR 22.52), allergic rhinitis (OR 8.468), and family history of HRS (OR 32.602) (all p < 0.001). PCA showed overlap but distinct clustering: HRS was characterized by sinonasal and otologic features, whereas migraine clustered around sensory hypersensitivity.
Conclusions:
Pediatric HRS shows distinct predictors-young age, acute severe headache, nasal and auditory symptoms, allergic history, and family history-despite overlap with migraine and TTH. Structured use of these predictors with otolaryngologic assessment may improve diagnostic accuracy, reduce misclassification, and avoid unnecessary neuroimaging or inappropriate therapy.
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