A review of 39 studies by researchers at the University of Wisconsin School of Medicine and Public Health shows functional nasal surgery can reduce or eliminate chronic headaches in some patients.

Functional nasal surgery is used to relieve obstructed breathing. It improves nasal airway breathing, allergy symptoms and obstructive sleep apnea. But this is the first time a review of evidence shows that surgery on nasal mucosal contact points, believed to serve as trigger points for chronic headaches, may relieve headaches for selected patients.

Contact points occur when contact remains after using a topical decongestant. The research by Ahmed Afifi, MD, associate professor of surgery, showed that 85 percent of patients who had functional nasal surgery had at least partial improvement in chronic headaches.

“Functional nasal surgery is a viable option to improve headache symptoms in appropriately selected patients,” said Afifi. But he said there is a need for randomized trials that include careful selection of patients most likely to benefit from surgery to relieve chronic headaches.

Findings confirm importance of individualized treatments

Afifi and his research team reviewed 39 studies that reported on nearly 1,600 patients who underwent functional nasal surgery for treatment of headache due to contact points. Among the most common surgeries were those for deviated septums or excess sinus tissue. About half the studies involved surgery in patients with chronic sinus infections.

  • Forty-eight percent of patients reported their headaches had gone away after surgery.
  • Another 37 percent said they had improvement in headache frequency or severity.
  • Only 15 percent said there was no change.

Patients who received a local anesthetic nerve block and had relief from headaches were more likely to respond to the surgery.

“Taken together, these results underscore the importance of a thorough diagnostic workup to help tailor individualized surgical treatment to each patient’s unique anatomy,” according to Afifi’s research team.

The study was published in the December issue of Plastic and Reconstructive Surgery, the medical journal of the American Society of Plastic Surgeons.