According to the neurology and headache literature, people who have migraine headaches have an imbalance of their pain control system.  There’s an area in the part of the brain, called the raphe magnus, that has two kinds of neurons or nerve cells, ON CELLS and OFF CELLS which control the transfer of pain stimulations.

These pain stimulations originate from the trigeminal nerve (the nerve which gives sensation to the head and face) and travels to the cortex of the brain which recognizes and feels the pain.

In migraine patients, the ON CELLS are more active than the OFF CELLS, so when mild to moderate pain stimulation travels toward the brain, the migraine patient actually feels more severe pain due to an exaggerated ON CELLS response.  Migraine patients have much less tolerance to pain stimulations. During some migraine attacks, it is not only difficult, but painful to comb their hair or even to wear a watch.

When pain sensation passes a certain threshold in migraine patients, the chemical CGRP is secreted at the trigeminal nerve endings.  This chemical is an irritant and will cause swelling of the surrounding tissues.  Migraine medications work by mostly preventing secretion of CGRP or neutralizing the effect of it.

As we know from experience, the human body will develop a tolerance to these medications and as time goes on, the effect of these medications will be less and less.

Also, frequent attacks of migraine headaches in an individual who suffers from migraines will change the balance of the pain control system in favor of the ON CELLS.  This is the reason why every year, roughly 3% of the migraine population will advance to a transformed migraine or daily headaches with frequent migraine attacks.

In a group of patients who have INTRANASAL CONTACT POINTS (two area inside the nose pushing against each other), when a mild headache starts, CGRP secretion causes  swelling of the nasal mucosa that will cause more pressure between these two surfaces, which in turn, causes more headache, and therefore more secretion of CGRP.  In a sense, this is a vicious cycle which causes a severe headache or migraine attack. By surgical removal of the intranasal contact point, the vicious cycle is broken and the headache will not progress to migraine attack.
This operation, although safe, is not for everyone who suffers from migraines.

For more information please visit    http://www.headachesurgery.com

There is a group of patients with headaches that clinically appeared to be migraine and not responsive to medical management but had intranasal contact points seen on CT scans. If these patients responded to temporary intranasal nerve block they had dramatic improvement after modified intranasal sinus surgery.

There are multiple reports in Otolaryngology and Headache literature regarding contact point headaches.  Recognizing the relationship between the migraine headaches and intranasal contact points is traced back as early as 1954 to Dr Williams. He emphasized that “intranasal contact point headache” is produced by pressure of the septum against the turbinate and advocated that removal of the contact point structures as one of the treatment modalities. Since then many authors researched and advocated that removal of intranasal contact points could cure the headache part of migraine disease.

In 2006, Behin et al reported an analysis of 10 studies with a total of 251 patients who had undergone this procedure for headache relief. This data included multiple diagnoses including sinus headache, migraine, transformed migraine, refractory migraine and cluster headaches. Follow up period ranges between six months to ten years.

39% reported having complete relief of their headache, 35% were improved and only 26% did not have noticeable improvement).

Progress in Migraine research. Nova Publication.
www. novapublisher.com

Migraine and nasal surgery

Numerous reports in the literature suggest that in appropriately selected patients, intranasal surgery can relieve headaches that appear to be migraine. In addition nasal congestion and pain commonly occurs in the course of a migraine attack.  By reviewing the current literature on pathophysiology of migraine, intranasal contact point headaches and anatomy of the nasal cavity. We may be able to explain a relationship between migraine and intranasal contact points. Migraine headache cure, Behin MD 1

Headache is one the most common medical complaints of civilized society.  In 2004, The International Headache Society instituted a classification system for headache that has become the international standard for headache diagnosis and clinical research. Contact Point Headaches is classified as A11.5.1 and most of the symptoms and signs are similar to migraine headaches.

A group of patients who suffer from migraine headaches have intranasal contact point and could benefit from this operation which either eliminates there headache or reduce it to a level that responds better to medications.