A case of an uncommon anatomic variation of the middle turbinate associated with headache

Headache due to the pressure of nasal mucosa in the absence of inflammation of the nose and paranasal sinuses is a clinical entity that has gained wide acceptance. Concha bullosa is the most commonly observed anatomical variation of the lateral nasal wall. The case is presented of a 31-year-old female with a history of intermittent frontal headache and bilateral nasal obstruction in whom we found the concha bullosa containing another, smaller concha bullosa inside. This is the first report of a case in which both outer and inner concha bullosa were septated (with two air cells inside). After resecting the lateral portion of outer concha bullosa and removing the inner concha bullosa, the patient reported no further headaches. The differential diagnosis of the variations of the middle turbinate and the relationships between the anatomic variations and pathophysiology of contact point headaches are discussed herewith.