Can Functional Nasal Surgery Treat Chronic Headaches? A Systematic Review

Background: Nasal surgery is one of the most common operations performed by plastic surgeons. The link between functional nasal surgery and improvement in nasal breathing is well established, but there are other metrics that have been shown to improve as a result of anatomical correction of the nose. Current literature suggests that surgery to remove nasal mucosal contact points can reduce symptoms in chronic headache patients. The authors conducted a systematic literature review to determine the validity of this hypothesis. Methods: A systematic search of the literature was performed using the terms headache, rhinogenic headache, contact point, migraine, and surgery/endoscopy. Results: The authors identified 39 articles encompassing a total of 1577 patients who underwent surgery to treat mucosal contact point headaches. Septoplasty and turbinate reduction were the most commonly performed procedures, often in combination with endoscopic sinus surgery. Analysis of the combined data demonstrated improvement in the reported severity of patient symptoms, with 1289 patients (85 percent) reporting partial or complete resolution of headaches postoperatively. Average visual analogue scale scores and number of headache days in patients undergoing nasal surgery were reduced from 7.4 0.9 to 2.6 +/- 1.2 (p < 0.001) and 22 +/- 4.3 days to 6.4 +/- 4.2 days (p = 0.016), respectively. Improvement in headache symptoms was significantly associated with a positive response to preoperative anesthetic testing, and with inclusion of endoscopic sinus surgery as part of the surgery. Conclusion: Functional nasal surgery is a viable option to improve headache symptoms in appropriately selected patients.