Endonasal Endoscopic Management of Contact Point Headache and Diagnostic Criteria

Headache: The Journal of Head and Face Pain, 10/07/09 Published Online: 5 Oct 2009

Alireza Mohebbi, MD; Framarz Memari, MD; Saleh Mohebbi, MD
From Hormozgan University of Medical Science (HUMS), Bandar abbas, Iran (S. Mohebbi); Iran University of Medical Science – Otolaryngology, Head and Neck Surgery, Tehran, Iran (A. Mohebbi and F. Memari).
Correspondence to S. Mohebbi, Otolaryngology, Shahid Mohammadi Hospital, Jomhori Eslami Ave., Bandar Abbas 79199-15519, Iran.
Results of this research were presented on 13-16 November 2007 at the 10th International Congress of Otolaryngology Head and Neck Surgery at Milad Hospital in Tehran, Iran.

Conflict of Interest: None

Copyright Copyright © 2009 American Headache Society

ABSTRACT
Background.—Some types of headaches with sinonasal origin may be present in the absence of inflammation and infection. The contact points between the lateral nasal wall and the septum could be the cause of triggering and sustained pain via trigeminovascular system.

Objective.—The aim of this study was to evaluate the feasibility and effectiveness of endoscopic surgery in the sinonasal region for treatment of headache with special attention paid to specific diagnostic methods and patient selection.

Methods.—This was a prospective, non-randomized and semi-quasi experimental research study. Thirty-six patients with chronic headaches who had not previously responded to conventional treatments were evaluated by rhinoscopy and/or endoscopy, local anesthetic tests and computed tomography scans as diagnostic criteria. These patients were divided into 4 groups based on the diagnostic methods utilized. The intensity of headaches pre- and post-operatively were recorded by utilizing the visual analog scale scale and performing analysis with analysis of variance test comparison and Statistical Package for Social Sciences. Average follow-up was 30 months.

Results.—Our overall success rate approximated 83% while the complete cure rate was 11%. Patients in group 4 achieved the best results. In this group all diagnostic criteria were positive. In addition, patient responses were statistically significant in groups with more than one positive criteria compared with group 1 who only had positive examination. The positive response of 14 migrainous patients diagnosed with migraine prior to treatment was 64%.

Conclusion.—Surgery in specific cases of headaches with more positive evidence of contact point could be successful, particularly if medical therapy has failed.