Nonsurgical versus endoscopic sinonasal surgery for rhinogenic headache

Headaches of sinonasal origin have been described lately. Terms such as middle turbinate syndrome have been used to describe this entity. The true incidence of this headache is unknown. A concha bullosa or a hypertrophied middle turbinate have been associated with these cases. Mucosal contact between the middle turbinate and the nasal septum or the lateral wall of the nose have been attributed as the cause of referred pain in the face. We present data on 23 individuals with refractory primary headache in the absence of any significant sinus symptoms. The duration of the symptoms of these individuals ranged between 4 and 13 years with a mean of 7.2 years. Fifteen patients agreed to undergo surgery, whereas eight refused surgery. After a mean of 23 months of follow-up, all those who did not have surgery continued to have pain that required excessive medications, whereas 60% of those who had surgery reported marked relief of their headaches. Those who had symptoms for less than 7 years had a greater chance of success (OR = 2). Sinonasal surgery seems to be helpful in alleviating primary headaches, especially in individuals whose duration of symptoms is less than 7 years.