Surgical treatment of patients with refractory migraine headaches and intranasal contact points

Fereidoon Behin, B. Behin, M. E. Bigal, Richard B. Lipton

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Contact point headaches have been attributed to intranasal contact between opposing mucosal surfaces, resulting in referred pain in the distribution of the trigeminal nerve. In subjects with primary headaches, contact points may be associated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and radiographic evidence of contact points in the sinonasal area. We reviewed charts of patients who underwent endoscopic sinus surgery and septoplasty for contact point in the same surgical facility, from October 1998 through August 2003. Subjects eligible for surgery had: (i) refractory migraine (failed to standard pharmacological headache treatments) or refractory transformed migraine; (ii) contact points demonstrated by computed tomography scan; (iii) reported significant headache improvement after topical anaesthesia to the contact area. Headache characteristics were assessed preoperatively and at follow-up (6-62 months after surgery) using a standardized questionnaire. A total of 21 subjects (72.5% women) were assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days per month (P = 0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-10 scale (P = 0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P < 0.0001). A total of 16 subjects (76.2%) had their headache scores improved by 50% or more; nine (42.9%) were pain free at the last follow-up. A total of 18 (95.8%) had at least a 25% reduction in their headache scores. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, and positive response after topical anaesthesia, surgical approach toward the triggering factor may be useful. Prospective studies are necessary to confirm our results.

Original languageEnglish (US)
Pages (from-to)439-443
Number of pages5
JournalCephalalgia
Volume25
Issue number6
DOIs
StatePublished - Jun 2005

Fingerprint

Migraine Disorders
Headache
Therapeutics
Anesthesia
Referred Pain
Trigeminal Nerve
Tomography
Prospective Studies
Pharmacology

Keywords

  • Contact point
  • Migraine
  • Refractory headache
  • Surgical treatment
  • Trigger point

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Surgical treatment of patients with refractory migraine headaches and intranasal contact points. / Behin, Fereidoon; Behin, B.; Bigal, M. E.; Lipton, Richard B.

In: Cephalalgia, Vol. 25, No. 6, 06.2005, p. 439-443.

Research output: Contribution to journalArticle

Behin, Fereidoon ; Behin, B. ; Bigal, M. E. ; Lipton, Richard B. / Surgical treatment of patients with refractory migraine headaches and intranasal contact points. In: Cephalalgia. 2005 ; Vol. 25, No. 6. pp. 439-443.
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abstract = "Contact point headaches have been attributed to intranasal contact between opposing mucosal surfaces, resulting in referred pain in the distribution of the trigeminal nerve. In subjects with primary headaches, contact points may be associated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and radiographic evidence of contact points in the sinonasal area. We reviewed charts of patients who underwent endoscopic sinus surgery and septoplasty for contact point in the same surgical facility, from October 1998 through August 2003. Subjects eligible for surgery had: (i) refractory migraine (failed to standard pharmacological headache treatments) or refractory transformed migraine; (ii) contact points demonstrated by computed tomography scan; (iii) reported significant headache improvement after topical anaesthesia to the contact area. Headache characteristics were assessed preoperatively and at follow-up (6-62 months after surgery) using a standardized questionnaire. A total of 21 subjects (72.5{\%} women) were assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days per month (P = 0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-10 scale (P = 0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P < 0.0001). A total of 16 subjects (76.2{\%}) had their headache scores improved by 50{\%} or more; nine (42.9{\%}) were pain free at the last follow-up. A total of 18 (95.8{\%}) had at least a 25{\%} reduction in their headache scores. Two patients (9.5{\%}) had increase in their headache score by less than 25{\%}. For selected patients with refractory headaches, demonstrable contact points, and positive response after topical anaesthesia, surgical approach toward the triggering factor may be useful. Prospective studies are necessary to confirm our results.",
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