鼻内接触性头痛的发病机制及诊治

Pathogenesis and treatment of intranasal contact point headache

目的探讨鼻内接触性头痛的发病机制及其有效的诊治手段。方法回顾性分析73例鼻腔接触性头痛患者的临床资料,经鼻窦CT及内镜检查评估鼻腔解剖异常情况及接触类型,同时测定骨间隙CT值,并通过内镜手术纠正鼻腔解剖结构异常。结果73例中,67例局部麻醉后头痛消失,5例上颌窦穿刺后头痛消失;内镜检查发现,73例中筛泡肥大31侧,钩突肥大、内移、气化59侧,中鼻甲异常91侧,鼻中隔高位偏曲51例,其中57例存在同侧2处及以上相邻解剖结构黏膜接触。73例中,术后1周内头痛消失64例(87.67%),头痛减轻9例(12.33%)。随访12个月,痊愈59例(80.82%),有效12例(16.44%),无效2例(2.74%)。结论接触性头痛患者鼻腔解剖异常以鼻中隔高位偏曲、中鼻甲变异及其邻近结构的病变最明显。解剖结构黏膜挤压及鼻窦自然口阻塞是接触性头痛的主要原因,内镜及鼻窦CT结合局麻试验可有效诊断鼻内接触性头痛。

Objective To investigate the pathogenesis, diagnosis and therapy of intranasal contact point headache. Method The clinical data of 73 patients with contact point headache between the septum and the lateral nasal wall were retrospectively reviewed and the anatomical abnormality of nasal carity was determined by CT scanning of the sinuses and endoscopy. All the patients underwent surgical intervention for correcting the abnormal anatomical conditions of nasal cavity. Results The headache disappeared in 67 of the 73 patients after topical anesthesia, and in the 6 remainders after maxillary sinus puncture. Among the anatomic variations in all the cases, endoscopy revealed that 31 sides there was hypertrophy of ethmoidal bulla, hypertrophy and medial deriation of processus uncinatus in 59 cases, abnormality of middle turbinate in 91 sides, and upper nasal septal deviation in 51 cases. Among the 73 cases, there was confact of two or mose sites of mucosa of the abnormalities in 57 cases. The headache disappeared in 64 patients （87. 7%） one week after operation, and it was reduced in 9 cases （12. 3%）. 12-month follow-up showed recovery in 59 cases （80. 8%）, in 12 cases （16. 4%） it was partially relieved, and in 2 cases （2. 7%） there was no effect. Conclusions Abnormal nasal septa, enlarged turbinates and other anatomic abnormalities are the most common findings in contact point headache. Pressure due to mucosal contact between the septum and lateral nasal wall mucosa, and maxillary sinus orifice occlusion are the major causes of contact point headaches. Endoscopy, CT scanning, and topical anesthesia are ideal in diagnosis of intranasal contact point headache.