Migraine and nasal surgery for intranasal contact point, pathophysiology.

Understanding the role of contact points as an exacerbating factor for migraine requires a brief review of the anatomy of the nasal cavity. The nasal septum divides the nasal cavity into right and left chambers. The lateral walls of the nasal cavity consist of the superior turbinate, medial wall of the ethmoid sinuses, middle turbinate and inferior turbinate. Note the space between the septum and superior turbinate, medial walls of ethmoid sinuses and the middle turbinate.

If the septum is pressing against any structure of the lateral wall of the nasal cavity it creates a contact point which could be in one site or multiple sites. Contact point between the nasal septum and middle turbinate on the right side, and medial wall of ethmoid sinus on the left.

The Trigeminal nerve supplies sensation to the nasal cavity which also innervates the structures inside the skull.

The nasal mucosa and intranasal structures are very sensitive to pressure. When there is pain of certain intensity in the head and neck area (supplied by trigeminal nerve and cervical verves that are connected to each other) a special chemical (CGRP) secreted at the nerve ending which causes swelling of the nasal mucosa, This swelling will create more pressure on the septum at the contact point sites which translate to more pain therefore more CGRP secretion. This is a vicious cycle that gets worse as minutes go by. It takes about 20 to 30 minutes to build up (the usual time for the migraine headache from start to peak).

By removing the contact points in the nasal cavity the headaches will not progress to the maximum level and usually could be treated with mild pain killer or in the case of transformed migraine responds to migraine medications.

http://www.youtube.com/watch?v=ULwOBSdezEs

Surgery Eliminates Nasal Pressure That Can Lead to Headaches

Simple nasal surgery seems to cure or reduce the number of migraine in some patients.  (AP Photo)

March 11, 2006 — Bonnie Muir has lived with paralyzing migraines since she was a teenager. At times, her headaches and the nausea that follows have been so unbearable that she has dunked her head into a sink full of ice to dull the pain.

“If the headache is bad, you can’t do anything,” Muir said. “I mean dark room, shades drawn, no sound. You take your medication. Sometimes the medication just doesn’t work.”

So when Muir, 54, of Hoboken, N.J., heard about a simple nasal surgery that could cure or dramatically reduce the number of migraines in some patients, she tried it.

“It is a breakthrough for migraines,” said Dr. Fereidoon Behin of Christ Hospital in Jersey City, N.J. “Hers will be much, much less than they were before, and she doesn’t need any migraine medication.

Dr. Nancy Snyderman, vice president at Johnson & Johnson, believes the treatment can cure a portion of migraine sufferers.

“I think there probably is a small subset of people who could benefit from this,” she said.

Snyderman advocates asking a number of questions before embarking on surgery, such as, “Do you have a good ear, nose and throat doctor in your community who is skilled at this kind of surgery?” and finally, “Have you had a CAT scan of your sinuses?”

Doing homework is the key because nasal surgery can lead to complications.

In Muir’s case, nasal surgery went off without a hitch.

Behin said some sufferers, like Muir, had pressure points in their nose that when combined with any number of triggers caused migraines. He used surgery to eliminate Muir’s nasal pressure by separating the bones pressing on the septum.

Behin said the surgery could work for about two-thirds of all migraine sufferers. Some doctors believe the number is far lower than his estimate and say symptoms can return.

It’s only been two months since Muir had the surgery, but already her life has changed dramatically.

“I couldn’t drink wine,” she said. “I couldn’t eat chocolate and, you know, I’ve done both with no ill effects since the surgery.”

For the first time in 40 years, Muir doesn’t live in fear of her headaches.

“I’m free,” she said. “It’s sort of given me a new sense of, of freedom and mobility that I haven’t had pretty much all my adult life.”

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.

Intranasal contact points and migraine headaches. 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 Publicatiom.

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