Intranasal Pathology in the Migraine Surgery Population: Incidence, Patterns, and Predictors of Surgical Success

Background: The purpose of this study was to identify patterns of nasal pathology in patients with rhinogenic migraine headaches (site III). Methods: A retrospective review was performed on patients with rhinogenic migraine headaches. Demographics, pre-and post-migraine surgery symptoms, and pathology seen on preoperative computed tomographic scans were reviewed. Results: Twenty percent of 98 patients had preoperative sinus disease. The following abnormalities were seen on computed tomographic scan: septal deviation, 75 (77 percent); septal spur, 33 (34 percent); middle concha bullosa, 48 (49 percent); sinus pathology, 20 (20 percent); and intranasal contact points, 62 (62 percent). A higher incidence of clinical sinusitis (20 percent migraine versus 5 to 15 percent in the general population) was also seen. Septoplasty was performed in 89 percent of patients, and conservative turbinectomy was performed in 60 percent of patients. Patients who failed surgery (<50 percent reduction in migraine headache index) had a significantly higher incidence of contact points (80 percent versus 56 percent; p = 0.034) than successful migraine patients. The surgery success group also had a higher incidence of preoperative middle concha bullosa compared with the failure group (71 percent versus 48 percent; p = 0.035). Conclusions: This is the first cohort study to identify the incidence and pattern of nasal pathology in migraine III patients. It is likely that the failure to achieve more successful outcomes in this patient population was the consequence of conservative nasal management and residual contact points because of concern for the development of nasal dryness. More frequent middle turbinate surgery may result in better clinical outcomes in this group of patients.