Rhinologic evaluation in patients with primary headache.

OBJECTIVES: In subjects with primary headaches, rhinologic pathologic condition may be associated with treatment refractoriness. In some cases, surgical correction of intranasal pathologic condition may decrease medication use. We aimed to evaluate the benefits of a rhinologic perspective in primary headache subjects by using neurologic management.

METHODS: Subjects with primary headache were examined by a neurologist and otolaryngologist. Initially, neurologic assessment was made, and medication was started. Migraine symptoms and pain severity were recorded using the Migraine Disability Assessment Scale and a 0 to 10 visual analog scale (VAS). Subject's pain severity of tension type headache was evaluated by VAS. Direct otorhinolaryngologic history of all primary headache subjects was taken, and they all underwent physical examination, rigid nasal endoscopy, sinus computed tomography, and mucosal contact point test. All examination and radiologic findings were noted. Subjects were separated into groups after 1-month medical neurologic management.

RESULTS: One hundred nine subjects were enrolled. Ninety-nine subjects completed follow-up. Seventy-eight percent of the subjects were women. The mean age was 33.6 years (range, 18-63 y). Twenty-six subjects had no significant intranasal pathologic condition (group 1). Twenty subjects had an intranasal pathologic condition but responded to the neurologic treatment (group 2). Fifty-three subjects had an intranasal pathologic condition, and the neurologic treatment failed for these 53 subjects. Surgical intervention was planned for these 53 subjects (group 3). Thirty-eight subjects accepted the operation (group 3a), and 15 subjects refused the surgical intervention (group 3b). All subject's Migraine Disability Assessment Scale and VAS scores were compared. A total of 73 subjects had rhinologic abnormalities. Groups 1 and 2 benefited from the neurologic treatment, but headache severity of group 3a reduced after rhinologic surgery. Group 3b who rejected surgical intervention did not respond to the neurologic treatment.

CONCLUSIONS: This study describes a series of subjects presenting with various primary headaches who also have underlying rhinologic abnormalities. Surgical treatment of the underlying rhinologic pathologic abnormalities had a beneficial effect on headache.