Nasal Surgery May Help Alleviate Chronic Headaches

A new study suggests that functional nasal surgery to relieve obstructed breathing can reduce or eliminate chronic headaches in selected patients.

Researchers at the University of Wisconsin (WISC; Madison, USA) and Cairo University (Egypt) conducted a systematic literature review in order to determine the validity of the hypothesis that nasal surgery to remove mucosal contact points can reduce symptoms in chronic headache patients. In all, the researchers identified 39 articles involving 1,577 patients who underwent surgery to treat mucosal contact points. Septoplasty and turbinate reduction were the most commonly performed procedures, often in combination with endoscopic sinus surgery (ESS).

An analysis of the combined data demonstrated an improvement in the reported severity of symptoms, with 85% of the patients reporting partial or complete resolution of headaches postoperatively. Average visual analogue scale (VAS) headache scores and number of headache days in patients undergoing nasal surgery was reduced from 7.4 and 22 days to 6.4 and 4.2 days, respectively. Improvement in headache symptoms was associated with a positive response to preoperative anesthetic testing, and with inclusion of ESS as part of the procedure. The study was published in the December 2018 issue of Plastic and Reconstructive Surgery.

“Taken together, these results underscore the importance of a thorough diagnostic workup to help tailor individualized surgical treatment to each patient's unique anatomy,” concluded lead author Ahmed Afifi, MD, of WISC, and colleagues. “Nasal mucosal contact points may be a viable surgical target to help improve headaches in appropriately selected patients. The good responses to nasal surgery suggest an important relationship between intranasal anatomy and headache feedback loops.”

The cause of rhinogenic headache was identified in 1988 as mechanical contact between two mucosal surfaces that creates a sensory stimulus responsible for the headache symptoms. Relieving septal deviations and sinonasal anatomic abnormalities contacting the nasal wall, middle or inferior turbinate, concha bullosa, pneumatized superior turbinate, and any other visualized mucosal contact point is considered the ideal treatment method to relieve these headaches.

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University of Wisconsin
Cairo University