The aim of this study was to determine the frequency of misdiagnosis of sinus headache in migraine and other primary headache types in the children and adolescents with chronic or recurrent headaches. Children with chronic or recurrent headaches (n = 310) were prospectively evaluated. Data collection for each patient included history of previously diagnosed sinusitis due to headache, and additional sinusitis complaints (such as fever, cough, nasal discharge, postnasal discharge) at the time of sinusitis diagnosis, and improvement of the headache following treatment of sinusitis. If sinus radiographs existed they were recorded. The study included 214 patients with complete data. One hundred and sixteen (54.2%) patients have been diagnosed as sinusitis previously and 25% of them had at least one additional complaint, while 75% of them had none. Sinusitis treatment had no effect on the headaches in 60.3% of the patients. Sinus graphy had been performed in 52.8%, and 50.4% of them were normal. The prevalence of sinus headache concomitant with primary headache, and only sinus headache was detected in 7 and 1%, respectively, in our study. Approximately 40% of the patients with migraine and 60% of the patients with tension-type headache had been misdiagnosed as “sinus headache”. Children with chronic or recurrent headaches are frequently misdiagnosed as sinus headache and receive unnecessary sinusitis treatment and sinus graphy.

In children with unexplained respiratory symptoms, laryngopharyngeal reflux should be suspected. Therefore, until enough data on this issue in the literature accumulates, the history and the laboratory findings of the patients obtained from various techniques to document paediatric LPR should be evaluated together.

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Case 1:A 9-y-old boy was admitted with a 1-wk history of headaches (in the left frontal area, vertex and neck), pain in the left ear, diplopia, feeling of annoyance by noise in the left ear, malaise, fatigue, loss of appetite, and paleness for 3 d. The patient had been initially treated by oral antibiotic (amoxicillin at a dose of 40 mg/kg/d) for pharengitis before admission. Previous medical history was unremarkable. There was no history of ear infections.On physical and neurological examinations, the patient was pale and weak. He kept his head towards the left for normal vision. In a neutral head position, the left eye was medially deviated and had lateral gaze paralysis not exceeding the midline (Figure 1). The left tympanic membrane was congested. There were no signs of meningial irritation or mastoid tenderness, and the rest of the physical and neurological examinations were unremarkable. The laboratory examination findings were as follows: white blood cells (WBC) 12 700/mm 3 , haemoglobin 12.7 g/dl, and platelet count 625 000/mm 3 . There were no pathological findings on the peripheral blood smear. Blood chemistry was normal. C-reactive protein (CRP) was 87 mg/l, and erythrocyte sedimentation rate (ESR) was 121 mm/h. Cerebrospinal fluid (CSF) findings were normal. Culture results of blood, urine, pus and CSF were negative. Serology of human immunodeficiency virus (HIV), herpes simplex virus, cytomegalovirus, rubella, measles, Epstein-Barr virus and parvovirus B19 were also negative. Figure 2.Figure 1.