This study investigates the relationship between headache and the occurrence of signs associated with intracranial hypertension (ICH) such as ophthalmic signs, restricted skull growth and a vertex bulge in children who were operated for sagittal synostosis.A total of 94 patients (aged 6-18 years) with sagittal synostosis were asked to indicate the headache frequency. Based on their age at referral, the patients had undergone either a fronto-biparietal remodeling (FBR) or an extended strip craniotomy (ESC). Data on fundoscopy, optical coherence tomography (OCT), occipitofrontal head circumference (OFC), and presence of vertex bulge on X-ray were collected retrospectively.Univariate analysis showed that ESC, the occurrence of ophthalmic signs, and a smaller OFC at last follow-up, were related to more frequent headaches (p=0.01, p=0.04, and p<0.01, respectively). In the multivariate analysis, only type of surgery and OFC at last follow-up remained significant predictors (p=0.04 and p<0.01 respectively).Although the reported rate of frequent headaches in this study is within the norm reported for the normal population, this study shows that after correction for sagittal craniosynostosis, frequent headaches are independently related to type of surgery and to OFC at last follow-up. Headaches in the sagittal craniosynostosis population may be related to papilledema and/or an increased TRT. Therefore, we recommend that OFC be routinely measured and that patients be asked about the occurrence and frequency of headaches during their checkup at the clinic.
