The outcomes for nasal contact point surgeries in patients with unsatisfactory response to chronic daily headache medications

Abstract

The nasal contact point may act as a trigger point or peripheral enhancer in patients with chronic daily headaches. A total of 42 patients had unsatisfactory response to medical treatment for chronic daily headache with radiologic evidence of nasal contact point. Of them, 12 (28.5%) patients were positive for the local anesthetic test. Those patients were operated upon to separate this contact by either septoplasties or submucous resections with or without partial turbinectomies. The mean headache frequency was reduced from 22 to 7 days/month. The mean headache severity was reduced from 5.6 to 2.4. Eight (19%) patients became completely free from headache and its medications, six (75%) of them were positive for local anesthetic test. The patients were satisfied with postoperative monotherapy, or headache severity and frequency could be tolerated without medications in 26 (62%) patients. There was no improvement in seven (16.6%) patients and only one patient (2%) became worse. The overall satisfaction was 83 and 81% for positive and negative anesthetic tests, respectively. The average monthly medication cost was reduced from $85 to 32. Nasal contact point surgery for chronic daily headache patients can satisfy them compared to previously unsatisfactory medications. Nasal contact point may contribute to potentiating or triggering chronic daily headache.

Intranasal contact points as a cause of facial pain or headache: a systematic review

“…suggest that a third person should question patients to ascertain postoperative benefit to reduce bias . If the surgeon who did the operation also evaluates the outcome this is susceptible to response bias and that was the case in the studies listed in Table .…”

“…To confound this selection process, some patients still benefit from surgery with a negative lidocaine test . Most studies report that a significant proportion of patients have residual symptoms after surgery in spite of the contact point having been removed.…”

Mucosal contact points and paranasal sinus pneumatization: Does radiology predict headache causality?

“…In spite of the low level of evidence, selected patients with mucosal contact points who appear to benefit from directed nasal surgery are those who have failed medical therapy for migraine and tension‐type headache, have otherwise normal endoscopy and CT scan, and have symptomatic improvement with local anesthetic application to the contact point in preoperative evaluation . However, it is not clear why a significant proportion of patients have residual symptoms after surgery . In addition, several studies claimed good response to surgical treatment in patients with less strict selection criteria.…”

“…[22][23][24] If intranasal mucosal contact is responsible for headache, then it is not clear why many patients with contact points do not have any pain symptoms. Although several authors have reported postoperative relief or improvement of headache in some patients, [25][26][27][28][29][30][31][32][33][34][35] almost all studies had no control subjects and many lacked long-term follow-up. 1,2 Therefore, headache improvement may be attributed to cognitive dissonance, a placebo effect that can last for several months, 36 or to neuroplasticity.…”

“…2 However, it is not clear why a significant proportion of patients have residual symptoms after surgery. [25][26][27][28][29][30][31][32][33][34][35] In addition, several studies claimed good response to surgical treatment in patients with less strict selection criteria. For example, migraine itself was hypothesized to be triggered at times by mucosal contact abnormalities and was found to respond to their surgical correction.…”