Department of Otorhinolaryngology, Haseki Training and Research Hospital, Health Sciences University, Istanbul, Turkey.
Department of Otorhinolaryngology, Acibadem Healthcare Group Taksim Hospital, Istanbul, Turkey.
Am J Otolaryngol. 2019 May-Jun;40(3):364-367. doi: 10.1016/j.amjoto.2019.02.002. Epub 2019 Feb 18.
Rhinogenic headache is a painful sensation in the head and face due to intranasal contact point without any mass or inflammatory findings. Surgery is recommended in patients with nasal obstruction; however the approach in case of isolated mucosal contact point that does not cause obstruction is controversial. Our aim is to observe changes in the severity of headache in patients with isolated mucosal contact point and headache who do not complain of nasal obstruction.
Our study included patients with unilateral headache without any nasal and/or paranasal sinus pathology. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography (CT). One hundred patients with isolated mucosal contact point without any problem in breathing were included in this study. All participants were treated by topical nasal corticosteroid for a month. Surgery was recommended to the patients with no satisfactory relieve of headache. Visual Analog Scales (VAS) were used to evaluate the severity of headache in patients at time of diagnosis (0 month), after a medical treatment (1st month) and after a surgical or medical treatment (6th month). The results were compared with each other statistically.
There was a decrease in VAS values after a month of medical treatment in all patients with isolated contact point (Z = -8.352; p = 0.0). VAS values significantly improved after surgical treatment group (Z = -4.97; p = 0.0). However, VAS values of patients increased at 6th month in medical treatment group (Z = -5341 p = 0.0). After a successful surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with surgical treatment group than in the patients with medical treatment group (Z = -8.441; p = 0.0).
Surgical correction provides a more effective outcome in patients with rhinogenic headache. However, it is difficult to convince that headache may improve with surgery in these patients especially with isolated mucosal contact point and without nasal obstruction. In order to prove the benefit of surgery, we believe that medical treatment can be used as a guide.
鼻源性头痛是一种由于鼻腔内接触点而引起的头部和面部疼痛，无肿块或炎症发现。对于有鼻腔阻塞的患者，建议手术；然而，对于没有引起阻塞的孤立粘膜接触点的处理方法仍存在争议。我们的目的是观察孤立粘膜接触点和头痛但不抱怨鼻塞的患者的头痛严重程度的变化。
我们的研究包括单侧头痛且无任何鼻腔和/或鼻窦病变的患者。我们通过鼻内窥镜和计算机断层扫描（CT）确认粘膜接触的存在。我们研究了 100 例有孤立粘膜接触点且呼吸无任何问题的患者。所有患者均接受鼻用皮质类固醇治疗一个月。对于头痛无明显缓解的患者，建议手术。视觉模拟量表（VAS）用于评估患者诊断时（0 个月）、药物治疗后（1 个月）和手术或药物治疗后（6 个月）的头痛严重程度。将结果进行统计学比较。
所有孤立接触点患者在药物治疗一个月后 VAS 值均下降（Z=-8.352；p=0.0）。手术组 VAS 值显著改善（Z=-4.97；p=0.0）。然而，在药物治疗组，患者在 6 个月时 VAS 值增加（Z=-5341，p=0.0）。在成功切除粘膜接触后，手术组患者头痛严重程度的下降幅度大于药物治疗组（Z=-8.441；p=0.0）。
手术矫正为鼻源性头痛患者提供了更有效的结果。然而，很难相信在这些患者中，特别是在孤立的粘膜接触点且没有鼻腔阻塞的患者中，手术可以改善头痛。为了证明手术的益处，我们认为可以将药物治疗作为指导。
