Surgical management of contact point headaches

Introduction.-Contact point headaches are caused by contact between the nasal septum and the lateral nasal wall by a mechanism of referred pain involving the trigeminal nerve. Our goal was to investigate headaches caused by the contact between the septum and the superior turbinate or medial wall of the ethmoid sinuses and not the middle turbinate. Materials and Methods.-A retrospective chart review was performed on patients who underwent septoplasty and sinus surgery for headache. The total number of patients who opted for surgery was 23. Only 12 patients met the criteria of having a contact point between the septum and medial wall of the ethmoid sinus, or septum and superior turbinate, which were demonstrated via CT scan of the sinuses. These patients underwent surgical intervention in order to relieve the contact points. Results.-According to the same pain questionnaire given pre- and postoperatively, 83% no longer complained of headaches, while 8% had significant relief. Forty-one percent of our patients were previously diagnosed with migraines; 80% of these patients were successfully treated by surgery. Discussions.-Contact point headaches and migraine without aura (MWOA) have similar symptoms (eg, photophobia, phonophobia, nausea and vomiting, pulsating nature). We believe contact point headaches should be considered in the patient with a diagnosis of MWOA headaches.