New research from the University of Wisconsin in Madison reports that 85% of patients who underwent functional nasal surgery had at least partial improvement in their headaches (Plast Reconstr Surg. 2018;142:1583-1592). They concluded that the use of nasal surgery to relieve obstructed breathing is a viable treatment option in appropriately selected patients with chronic headache.
The investigators conducted a systematic research review and identified 39 studies reporting on 1,577 patients who underwent functional nasal surgery for treatment of headaches due to mucosal contact points. The most common procedures were surgery to address a deviated septum or excess sinus tissue. Approximately half of the studies included endoscopic sinus surgery (ESS).
The data suggested that functional nasal surgery was highly effective in reducing or eliminating chronic headache symptoms. Nearly 48% of patients reported that their headaches were alleviated after surgery, while another 37% saw improvement in headache severity or frequency. Only 15% percent reported no change.
In a subset of studies, functional nasal surgery reduced the number of days with headache from approximately 22 to six days per month. Ratings of headache pain were also reduced.
Sometimes patients are selected for functional nasal surgery by a trial of a local anesthetic nerve block. Patients who had a positive result (relief from headache pain) on this nerve block test were more likely to respond well to surgery. Outcomes also appeared better when ESS was performed as part of the surgery.
The authors wrote that the positive responses to nasal surgery suggest an important relationship between intranasal anatomy and headache feedback loops.