Behin F, Behin B, Bigal M E, Lipton R B
Mount Sinai Medical Center, New York, NY, USA.
Cephalalgia. 2005 Jun;25(6):439-43. doi: 10.1111/j.1468-2982.2004.00877.x.
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.
接触点性头痛被认为是由于相对的黏膜表面之间的鼻内接触，导致三叉神经分布区域出现牵涉痛。在原发性头痛患者中，接触点可能与治疗难治性有关。我们旨在评估手术矫正对难治性偏头痛或转化型偏头痛患者以及鼻窦区域存在接触点影像学证据的患者的益处。我们回顾了1998年10月至2003年8月在同一手术机构接受内镜鼻窦手术和鼻中隔成形术治疗接触点的患者病历。符合手术条件的受试者具备：（i）难治性偏头痛（对标准药物性头痛治疗无效）或难治性转化型偏头痛；（ii）计算机断层扫描显示有接触点；（iii）报告称接触区域局部麻醉后头痛有显著改善。术前及随访时（术后6 - 62个月）使用标准化问卷评估头痛特征。共评估了21名受试者（72.5%为女性）。每月平均头痛次数从17.7天降至7.7天（P = 0.003）。头痛严重程度在0 - 10分的量表上从7.8降至3.6（P = 0.0001）。与头痛相关的残疾程度从5.6（10分制）降至1.8（P < 0.0001）。共有16名受试者（76.2%）头痛评分改善了50%或更多；9名（42.9%）在最后一次随访时无痛。共有18名（95.8%）头痛评分至少降低了25%。2名患者（9.5%）头痛评分增加不到25%。对于选定的难治性头痛、可证实的接触点以及局部麻醉后有阳性反应的患者，针对触发因素的手术方法可能是有用的。需要进行前瞻性研究来证实我们的结果。
