Contact Point Headache- Evaluation and Surgical Treatment

Abstract

Introduction: Contact point headache must be considered in patients who have no other identifiable cause of their headache. Otorhinolaryngologist should carefully evaluate the patients with headache for any possible contact points within the nasal cavity. Aim: To identify the incidence of contact point headache and evaluate the results of surgery in patients suffering from contact point headache. Materials and Methods: This longitudinal study was carried out from October 2005 to March 2006 in the Department of Otorhinolaryngology, Safdarjung Hospital, New Delhi, India. In this study 20 patients, presented to Ear, Nose and Throat Outpatient Department (ENT OPD) with complaints of headache, were screened for contact point headache. Detailed history were taken, diagnostic nasal endoscopy and computed tomography scan of nose and paranasal sinuses was done to demonstrate a contact point. A 4% xylocaine with adrenaline (1:100000 conc.) cotton swab pack was placed between the intranasal contact point for five minutes and relief of headache was noted, if any. A total of 18 septoplasties and two Middle Turbinate (MT) lateralisations were performed. Patients were followed-up for a period of four months postoperatively. Results: In the study, incidence of contact point headache was 13%. The headache duration ranged from 18-180 months, average duration being about 45.8 months. Postoperatively, 15 (75%) had total relief of their headache in terms of frequency, intensity and duration, 3 (15%) patients had significant relief and 2 (10%) had no relief of headache. Conclusion: The results for surgical treatment of contact point headache in the study have been rewarding, therefore surgery should be considered in patients whose headache are refractory to all forms of medication, with intranasal contact point, as an intranasal contact point may be the trigger factor for headache.

Keywords

• intranasal contact point
• middle turbinate lateralisation
• septoplasty