NIEHS trainees: hail fellows, well met.

Background: A pneumatized superior turbinate is a rare cause of headache. Nasal endoscopy alone, does not provide us with adequate information for this inaccessible area of the superior nasal cavity. A coronal computed tomography (CT) must be obtained to confirm the diagnosis. Case presentation: We present a 40-year-old female with migraine-type headache and nasal obstruction. Nasal endoscopy revealed a mild septal deviation, a right middle concha bullosa and a paradoxically curved middle turbinate on the left side. Coronal CT-scan showed also the presence of a superior concha bullosa on the left, which was in close contact with the nasal septum. The patient underwent septoplasty and bilateral endoscopic sinus surgery, including partial removal of both the pneumatized middle turbinates in conjunction with gentle lateralization and resection of the lower half of the left superior turbinate. Prompt relief from headache and nasal symptoms was obtained. Conclusion: Pneumatized superior concha causing migrainous headache is a rare finding. Endoscopic surgery may provide permanent relief of symptoms. Background The otorhinolaryngologic causes of headaches in most cases may be included in one of the following categories [1]: (1) Headaches associated with various sinus problems, most commonly acute or chronic rhinosinusitis; (2) headaches clearly connected to specific, easily recognizable nonsinus causes, such as neuralgias, migraine, otalgia, temporomandibular joint disease or vascular headaches; (3) non typical headaches, in patients with absence of sinus pathology. In the last group, midface discomfort, presenting as either pressure, fullness or even intense pain is a common occurrence. Its source may be dental, neural or nasal, presenting thus a challenge to the rhinologist. Nasal causes of headaches include deviated nasal septum, engorgement of the turbinates, nasal neoplasm, pneumatized agger nasi cells, unusual deflections of uncinate process, paradoxically bent middle turbinate and variations of ethmoid bulla [2]. Pneumatized turbinates have been reported as rare causes of headache that deserve further evaluation [3,4]. Published: 09 January 2007 Head & Face Medicine 2007, 3:3 doi:10.1186/1746-160X-3-3 Received: 20 October 2006 Accepted: 09 January 2007 This article is available from: http://www.head-face-med.com/content/3/1/3 © 2007 Homsioglou et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.