Introduction.Contact point headaches are caused by contact between the nasal s eptum and the lateral nasal wall by a mechanism of referred pain involving the t rigeminal nerve. Our goal was to investigate headaches ca...Introduction.Contact point headaches are caused by contact between the nasal s eptum and the lateral nasal wall by a mechanism of referred pain involving the t rigeminal nerve. Our goal was to investigate headaches caused by the contact bet ween the septum and the superior turbinate or medial wall of the ethmoid sinuses and not the middle turbinate. Materials and Methods.A retrospective chart revie w was performed on patients who underwent septoplasty and sinus surgery for head ache. The total number of patients who opted for surgery was 23. Only 12 patient s met the criteria of having a contact point between the septum and medial wall of the ethmoid sinus, or septumand superior turbinate, which were demonstrated v ia CT scan of the sinuses. These patients underwent surgical intervention in ord er to relieve the contact points. Results.According to the same pain questionnai re given pre-and postoperatively, 83%no longer complained of headaches, while 8%had significant relief. Forty-one percent of our patients were previously di agnosed with migraines; 80%of these patients were successfully treated by surge ry. Discussions.Contact point headaches and migraine without aura (MWOA) have si milar symptoms (eg,photophobia, phonophobia, nausea and vomiting, pulsating natu re).We believe contact point headaches should be considered in the patient with a diagnosis of MWOA headaches.展开更多
Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, conta...Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 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 scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.展开更多
文摘Introduction.Contact point headaches are caused by contact between the nasal s eptum and the lateral nasal wall by a mechanism of referred pain involving the t rigeminal nerve. Our goal was to investigate headaches caused by the contact bet ween the septum and the superior turbinate or medial wall of the ethmoid sinuses and not the middle turbinate. Materials and Methods.A retrospective chart revie w was performed on patients who underwent septoplasty and sinus surgery for head ache. The total number of patients who opted for surgery was 23. Only 12 patient s met the criteria of having a contact point between the septum and medial wall of the ethmoid sinus, or septumand superior turbinate, which were demonstrated v ia CT scan of the sinuses. These patients underwent surgical intervention in ord er to relieve the contact points. Results.According to the same pain questionnai re given pre-and postoperatively, 83%no longer complained of headaches, while 8%had significant relief. Forty-one percent of our patients were previously di agnosed with migraines; 80%of these patients were successfully treated by surge ry. Discussions.Contact point headaches and migraine without aura (MWOA) have si milar symptoms (eg,photophobia, phonophobia, nausea and vomiting, pulsating natu re).We believe contact point headaches should be considered in the patient with a diagnosis of MWOA headaches.
文摘Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 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 scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.
