Endoscopic Solution to Rhinogenic Contact Headaches

Abstract

Introduction
 Headache is a common complaint that brings patients to multidisciplinary clinics. It is utmost important to have meticulous clinical diagnosis of patients with rhinogenic and non sinusogenic headaches. The diagnosis has become easier with the advent of modern endoscopy and endoscopic sinus surgical techniques. This study aims to investigate the role of some anatomical nasal abnormalities in rhinogenic contact headache and to evaluate response to endoscopic surgery.
 
 Materials and Method
 A prospective study was conducted at a secondary level regional referral Hospital in the Sultanate of Oman. Patients with long-lasting, frequent, severe headaches not amenable to medical treatment, above 20 years of age were taken into consideration. Routine nasal endoscopy, Computerized tomography scan of the paranasal sinuses, Nasal decongestion and various surgical techniques to correct the anatomical abnormalities were included in our study and results were correlated statistically.
 
 Result
 There was a male predominance in our study with duration of headache ranging from 2 weeks to 5 years. There was a preponderance of headache in frontal region in our study group. Diagnostic nasal endoscopy and CT scan of PNS revealed Deviated nasal septum / septal spur, concha bullosa, Haller cell, pneumatised uncinate process and agar nasi cells. The overall success rate of the surgery in relieving headaches, measured by the MIDAS- VAS score, was approximately 75 %. The non-parametric Wilcoxon signed rank test, Chi square and paired T tests shows that the following study has rejected the null hypothesis as statistically significant where the P value <0.05.
 
 Discussion
 Researchers have examined the contact points as a source of rhinogenic / contact headache. Intranasal mucosal contact released substance P, causing pain and headache, Substance P has a potent vasodilator effect. Vasodilatation and perivascular inflammation are the final common pathways in pain. Surgical treatment for contact point-induced headaches has had good success.
 
 Conclusion
 The etiology of rhinogenic headache is multifactorial. Complete history taking, scrupulous preoperative evaluations, multidisciplinary consultations, Initial medical controls, long observation, and diligent postoperative follow-ups are mandatory for not only accurate diagnosis but also for promising surgical outcomes of non-sinusitis related rhinogenic headache. Our experience reveals that patients with rhinogenic contact headaches can benefit significantly from meticulous endoscopic decompression

Etiology of ‘Sinus Headache’—Moving the Focus from Rhinology to Neurology. A Systematic Review

“…Consequently, the recent European guidelines do not recommend surgery for the treatment of headache or facial pain [ 11 , 12 ]. On the other hand, there exists a large group of authors who are proponents of MCP headache surgery [ 43 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. These authors indicate excellent results of case series and low-grade controlled trials.…”

The Role of Nasal Endoscopy in the Management of Rhinosinogenic Headache

“…Rhinogenic headache is due to mucosal contact points in absence of inflammation of mucosa, sinonasal polyp or mass, nasal discharge. It is also described in literature as four finger headache, contact point headache and Sluder headache [1]. There are various types of headache that can mimic rhinosinogenic headache like migraine, tension headache, neuralgia, cervical spine disorder, temporomandibular joint disorder, ophthalmic disorder, intracranial pathologies and vascular type headache.…”