Secondary headache as a presenting symptom of sinonasal undifferentiated carcinoma mimicking paranasal mucocele: case report and diagnostic implications

Abstract

Background
Secondary headaches can signal serious underlying conditions and require early recognition to guide appropriate diagnostic and therapeutic interventions. The SNOOP10 criteria assist clinicians in identifying red flags suggestive of secondary causes. Sinonasal tumors, such as mucoceles and undifferentiated carcinomas, may present with similar symptoms and radiological features, making differentiation challenging without histological confirmation.
Case Presentation
We report the case of a 32-year-old woman with a one-year history of right-sided pressing periocular headaches, initially responsive to NSAIDs. Over time, the pain intensified, became less responsive to treatment, and was associated with visual impairment, ptosis, and periorbital paresthesia. Imaging revealed a right maxillary paranasal mass initially suspected to be a mucocele. However, biopsy and immunohistochemistry confirmed a diagnosis of sinonasal undifferentiated carcinoma (SNUC). The patient underwent radiotherapy, with partial recovery of ocular motility and ptosis, though visual loss persisted.
Conclusion
This case illustrates the importance of recognizing red flags in headache evaluation and highlights the utility of the SNOOP10 tool in identifying secondary headache disorders. In patients with atypical headache patterns and orbital involvement, early imaging and biopsy are essential for accurate diagnosis and timely management.