Contact Point Headache

March 24, 2009; 72 (12) NEUROIMAGES

Intranasal contact point headache

Missing the “point” on brain MRI

Todd D. Rozen

First published March 23, 2009, DOI: https://doi.org/10.1212/01.wnl.0000345006.20397.98

Nasal septal deviation with a contact point on the lateral nasal wall can trigger episodic or daily headache.1 Nasal contact is easy to visualize on brain MRI; however, it is rarely reported by neuroradiology. Blockade of the contact point by ENT with lidocaine transiently alleviated headache in both patients. Nasal contact should be looked for on brain MRI as this is a treatable secondary cause of head pain.  At present, nasal contact surgery for headache has not been supported by randomized studies and is a procedure to be tried only in cases that fail conventional headache treatment and after ENT evaluation.

1 Behin F, Lipton RB, Bigal M. Migraine and intranasal contact point headache: is there any connection? Curr Pain Headache Rep 2006;10:312–315.PubMed

2 Behin F, Behin B, Behin D, Beredes S. Surgical management of contact point headaches. Headache 2005;45:204–210.PubMed

Contact Point Headache: What is it?

By Dr. Sumit Mrig  ENT

Contact point headache (anterior ethmoidal neuralgia) is a rare type of cerebral pain that causes extraordinary anguish and distress in many patients. It is an uncommon kind of a headache (sub-migraine) that displays itself as a persistent wounding or shooting pain in the single territory on face. It is possible that the patient will not be able to determine and treat this migraine. Several individuals see ENT surgeons, neurologists, dental practitioners, and specialists, despite that nobody is able to identify the cause of pain.

What causes it?

There is an anatomic spot inside the nose, which compresses the nerve between two structures. It closely resembles leg sciatica of the nose/face. The nerve that gets squeezed is either the front ethmoid nerve or the nerves in the sphenopalatine ganglion. Common reasons are:

·         Cold wave

·         Hypoglycaemia

·         Emotional burst

·         Lot of tea & coffee

·         Lack of sleep

·         Poor dietary habit

Most Common Symptoms

·         Severe pain on one side of the face

·         The pain usually begins if the person has had upper respiratory infection

·         Sudden excruciating pain of the trigeminal nerve on the face, area of the eye, retro orbital, behind the ear, neck and shoulder trigeminal nerve on the face, area of the eye, retro orbital, behind the ear, neck and shoulder

·         Pain can be due to noise and sensitivity to light

·         Photophobia, water from the eyes, irritability, anxiety, depression

·         Loss of interest at work & fatiguability.

Is there any Treatment available?

There is no pill or nasal shower that can cure contact point migraines. Nasal splashes and decongestants can help incidentally as these solutions reduce the mucosal swelling, thereby calming any pressure on the nerve. If in case, the mucosal swelling repeats, tormenting pain can return.  

The standard treatment to treat this issue is “Surgery” in order to address the basic anatomic structures prompting nerve pressure. Surgery will require fixing the septum or uprooting the septal goad.

What is the Diagnosis?

·         ENT assessment, for example, nasal endoscopy to affirm the vicinity of a basic issue.

·         CT scan of the sinuses - is an imperative test to see that there is no fundamental anatomic hard abnormalities or sinus pathology.

·         CT sweep of the neck should likewise be possible if there is neuropathy of the sphenopalatine ganglion nerve alongside endoscopic proposal of a conceivable tumour at the base of the skull.

·         X-ray output can be requested by a neurologist to avoid any hidden mind/spinal pathology.

·         Contingent upon the finding of the CT check and nasal endoscopy, there is an indicative test which should be possible where nasal endoscope "touches" the contact guide zone all together to check whether it worsens or recreates the contact point migraine. At that point, there is a subsequent test done where a decongestantdrug is connected to the area of the contact point to check whether it mitigates the torment.