2. Observation
and Results
• 120 subjects with Rhinogenic Headache
• Dominating in female (55,84%) and age
groups of 21-30 years (34,16%)
• Deviated nasal septum, septal spur,
concha bulosa, and bulla ethmoidalis
were more common in Rhinogenic
headache patients
3. Observation and
Results
• The most prevalent location
of rhinogenic headache was
the glabella/frontal region
(34,16%)
• Not significantly
significance in statistical
analysis (p value 0.84)
• The most common mucosal
contact zones were middle
turbinate and nasal septum
(48.33%), followed by
middle turbinate and
ethmoid bulla
4. Observation and Results
• The longest duration and most
frequent of headache before
surgery was septal spur (14
hour/day and 16 days/month)
• The concha bullosa was the
most intense of headache,
followed by septal spur (VAS
7-8)
• Overall, the duration of
headache was 12 hour/day, the
frequency of headache was 11
days/month, and the intensity
of headache was 6 out of 10
5. Observation
and Results
• The most common surgical
procedure that performed in
rhinogenic headache was
septoplasty (51,36%), followed
by FESS (21,67%), concha
reduction, and inferior
turbinate cauterization.
6. Observation
and Results
• Only malformation of uncinate was found
insignificant stastically in duration and
frequency of headache before and one month
after surgery
• Concha bullosa and deviated nasal septum were
the most significant improvement in headache
duration, frequency, and intensity at 6 month
after surgery
• Headache intensity was insignificant between
one month and six month after surgery.
• The improvement of headache intensity was
insignificant in cases of concha bullosa at 1
year follow up
7. Observation
and Results
• Surgical management led to a
significant reduction in
headache duration, frequency,
and intensity, with the overall
success rate being 89.16%
(completely 44.16%,
significantly 45%)
8. Discussion
• Mucosal contact point headache is common at the age of 20
years as the completion of facial skeleton growth
• The majority in this study : 21-30 age groups and female
• Ghazipour et al : dominating in males
• Deviated nasal septum, septal spur, concha bullosa, malformed
uncinate, nasal polyp, ethmoid bulla were seen as the cause of
rhinogenic headache
• Zinrich et al: concha bullosa was the majority cause, based
on CT
• On contrary, less common in nasal polyposis (due to reduce
innervation of polyp)
• Bektas et al: concha bullosa, deviated nasal septum, septal
spur were seen as the most prominent finding
9. Discussion
• Common sites of headache: glabella/frontal region (34,16%), frontotemporal
(17,50%), multisites (19.16%)
• Ghazipour et al and Harly et al reported similar findings
• Majority of mucosal contact points: middle turbinate and nasal septum (48.33%),
middle turbinate and ethmoid bulla (23.33%)
• Similar result in Morgenstein et al and Welge Luessen et al termed it as
middle turbinate headache syndrome
10. Discussion
• Intensity of headache (VAS): concha bullosa (7.67±1.63), septal spur (7.54±1.26),
deviated nasal septum (6.37±1.39)
• Peric et al: Septal spur, concha bullosa, and deviated nasal septum respectively
(VAS 7)
• Duration of headache (hour/day): septal spur, paradoxical turbinate, ethmoid bulla,
concha bullosa (10-14 hour)
• Peric et al: longer in septal spur, concha bullosa, deviated nasal septum
• Frequecy of headache (day/month): septal spur, deviated nasal septum, concha
bullosa, ethmoid bulla
• Peric et al: often in septal spur, concha bullosa, and deviated nasal septum
11. Discussion
• Mean difference between preoperative and
postoperative in duration, frequency, and
intensity of headache : 9.94±3.57 hour/day,
9.65±3.91 day/month, 4.03±1.74 (VAS) overall
success rate: 89.16% (completely 44.16%,
significantly 45.00%)
• Parson et al reported 91% decrese in intensity and
84% decrease in frequency after surgery in
Rhinogenic headache
• Das et al: headache improved in 89.33% after surgery
12. Discussion
• The major improvement in headache at first post
operative visit after 1 month final outcome
evaluation needs a longer follow up to see
reccurence of headache
• Sadeghi et al: the intensity was significant
difference at 1 month, no same result between 1
month and 6 month visit
• Peric et al: headache intensity was significant
improvement at 1 month, not much difference at 6
months, 1 year, 2 years
• Welge Luessen et al: long follow up 10 years, only
65% improvement of headache
• Tosun et al: 43% complete remission, 47%
13. Discussion
• Inconsistent result in cases of concha bullosa
and malformed uncinate
• Surgical correction may disturb the streamline
airflow of middle meatus mucosal hypertrophy and
blockage of infundibulum recurrence headache
• In cases of nasal polyp, the headache was mild
in intensity with lower side of duration and
frequency
• Hyperplastic mucosa of nasal polyp sparse nerve
fibers less release of substance P and other
vasoactive substance
• Not much difference in headache even after surgery
in nasal polyp
14. Discussion
• VAS scale for headache crude scale
• Not have a control group placebo effect could not
be ruled out
• Studies with a control group and longer follow up
would predict better about recurrence of headache
after surgery
• Mucosal contact points may not be the only one
underlying cause (only trigger points)
• The absence of headache in early post operative
period may not result in long term control and
headache may recur
15. Discussion
• Post operative evaluation showed still 10.83%
patient with resistance headache after surgery
• Abu Bakra and Jones rhinogenic headache is a
central pathology, and surgery has no role
16. Conclusion
• Importance of targeted surgical intervention
after proper evaluation in patient suffering
rhinogenic headache
• Early diagnosis and timely surgical
intervention significantly improve the
quality of professional and social well being
in majority of patients
• The effect of surgery needs long follow up to
shoe the true extent of effectiveness
