Wang Jia, Yin Jin-Shu, Peng Hong
Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Tieyi Road 10#, Haidian District, Beijing, China 100038.
Ear Nose Throat J. 2016 Jun;95(6):E39-44.
We aimed to investigate the differences in incidence of nasal anatomic abnormalities between patients with and without headache and the outcome of surgical treatment for the headache patients with mucosal contact points. We conducted the observational study and recruited 107 subjects without headache (nonheadache group) and 78 patients with recurrent headache for more than 2 years (headache group). Study participants underwent high-resolution sinus computed tomography scans, and the incidence of nasal anatomic abnormalities was calculated in both groups. An additional 25 patients with recurrent headache underwent endoscopic surgical treatment. Mucosal contact points were observed in 85.9% of patients with recurrent headache and also in 80.4% of participants without headache. The most common mucosal contact point was between a deviated nasal septum and lateral nasal wall (41.1%). The incidence of deviated nasal septum contacting with lateral nasal wall was significantly different between the headache group (55.1%) and the nonheadache group (40.2%) (p < 0.05). The postoperative pain scores of the additional 25 headache patients with recurrent headache and mucosal contact point who were treated with endoscopic surgery decreased significantly compared with their preoperative measurements (p < 0.001), but only 44% of patients had recovered from headache 7 days postoperatively. We conclude that some patients with recurrent headache may not have a mucosal contact point, and some patients with mucosal contact points may not meet the diagnostic criteria of mucosal contact point headache since pain was not resolved within 7 days after surgical treatment. The diagnostic criteria of mucosal contact point headache before surgery should be reevaluated.
我们旨在调查有无头痛的患者之间鼻解剖异常的发生率差异，以及患有黏膜接触点的头痛患者的手术治疗结果。我们进行了一项观察性研究，招募了107名无头痛的受试者（非头痛组）和78名复发性头痛超过2年的患者（头痛组）。研究参与者接受了鼻窦高分辨率计算机断层扫描，并计算了两组中鼻解剖异常的发生率。另外25名复发性头痛患者接受了内镜手术治疗。在85.9%的复发性头痛患者和80.4%的无头痛参与者中观察到黏膜接触点。最常见的黏膜接触点是鼻中隔与鼻外侧壁之间（41.1%）。头痛组（55.1%）和非头痛组（40.2%）中鼻中隔与鼻外侧壁接触的发生率有显著差异（p<0.05）。另外25名接受内镜手术治疗的复发性头痛且有黏膜接触点的头痛患者术后疼痛评分与术前测量值相比显著降低（p<0.001），但术后7天只有44%的患者头痛缓解。我们得出结论，一些复发性头痛患者可能没有黏膜接触点，一些有黏膜接触点的患者可能不符合黏膜接触点性头痛的诊断标准，因为手术治疗后7天内疼痛未缓解。术前黏膜接触点性头痛的诊断标准应重新评估。
