Functional nasal surgery relieves chronic headache for some patients

Nasal surgery to relieve obstructed breathing can reduce or eliminate chronic headaches in selected patients, reports a paper in the December issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Eighty-five percent of patients undergoing functional nasal surgery had at least partial improvement in their headaches, according to a research summary and update by Ahmed M. Afifi, MD, and colleagues of University of Wisconsin, Madison. They write, "These results suggest that the use of nasal surgery to improve headache symptoms is a viable treatment option in appropriately selected chronic headache patients."

Nasal Surgery Improves Headache by Addressing 'Contact Points'

The researchers analyzed available evidence from previous studies of nasal surgery to treat chronic headache. These procedures target "contact points" within the nose and sinuses, which are believed to serve as trigger points for chronic headaches. This type of surgery is often done as part of functional nasal surgery to relieve obstructed breathing. Functional nasal surgery has been shown to improve nasal airway breathing, allergy symptoms, and obstructive sleep apnea.

A systematic research review identified 39 studies reporting on 1,577 patients who underwent functional nasal surgery for treatment of headaches due to mucosal contact points. The most common procedures were surgery to address a deviated septum or excess sinus tissue. About half of the studies included endoscopic sinus surgery (ESS), often performed in patients with recurrent sinus infections.

The data suggested that functional nasal surgery was highly effective in reducing or eliminating chronic headache symptoms. About 48 percent of patients reported that their headaches were cured after surgery, while another 37 percent had improvement in headache severity or frequency. Only 15 percent reported no change.

In a subset of studies, functional nasal surgery reduced the number of days with headache: from approximately 22 to six days per month. Ratings of headache pain were also reduced.

Sometimes patients are selected for functional nasal surgery by a local anesthetic nerve block. Patients who had a positive result (relief from headache pain) on this nerve block test were more likely to respond well to surgery. Outcomes also appeared better when ESS was performed as part of the surgery.

The paper is the first systematic review of evidence demonstrating that "nasal mucosal contact points may be a viable surgical target to help improve headaches in appropriately selected patients," Dr. Afifi and coauthors write. The good responses to nasal surgery suggest "an important relationship between intranasal anatomy and headache feedback loops."

"Taken together, these results underscore the importance of a thorough diagnostic workup to help tailor individualized surgical treatment to each patient's unique anatomy," the researchers write. They emphasize that the specific procedures performed in the studies varied substantially, as well as the need for consistent diagnostic criteria to identify chronic headache patients who might benefit from functional nasal surgery.

"Functional nasal surgery is a viable option to improve headache symptoms in appropriately selected patients," Dr. Afifi and colleagues conclude. They highlight the need for well-controlled randomized trials, including careful selection criteria to identify patients most likely to benefit from this surgical approach to treatment for chronic headache.