CT Imaging Biomarkers in Rhinogenic Contact Point Headache: Quantitative Phenotyping and Diagnostic Correlations

Rhinogenic contact point headache (RCPH) represents a diagnostic challenge due to different anatomical presentations and unstandardized imaging markers. This prospective multicenter study involving 120 patients aimed to develop and validate a CT-based imaging framework for RCPH diagnosis. High-resolution CT scans were systematically assessed for seven parameters: contact point (CP) type, contact intensity (CI), septal deviation, concha bullosa (CB) morphology, mucosal edema (ME), turbinate hypertrophy (TH), and associated anatomical variants. Results revealed CP-I (37.5%) and CP-II (22.5%) as predominant patterns, with moderate CI (45.8%) and septal deviation > 15° (71.7%) commonly observed. CB was found in 54.2% of patients, primarily bulbous type (26.7%). Interestingly, focal ME at CP was independently associated with greater pain severity in the multivariate model (p = 0.003). The framework demonstrated substantial to excellent interobserver reliability (κ = 0.76-0.91), with multivariate analysis identifying moderate-severe CI, focal ME, and specific septal deviation patterns as independent predictors of higher pain scores. Our imaging classification system highlights key radiological biomarkers associated with symptom severity and may facilitate future applications in quantitative imaging, automated phenotyping, and personalized treatment approaches.