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.