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Can Functional Nasal Surgery Treat Chronic Headaches? A Systematic Review

Farmer, Rebecca L., M.D., Ph.D.; Garg, Ravi K., M.D.; Afifi, Ahmed M., M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1583-1592
doi: 10.1097/PRS.0000000000004989
Reconstructive: Head and Neck: Original Article
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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.

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Madison, Wis.; and Cairo, Egypt

From the Division of Plastic Surgery, University of Wisconsin; and the Department of Plastic Surgery, Cairo University.

Received for publication October 30, 2017; accepted May 22, 2018.

Presented at the American Society of Plastic Surgeons Annual Meeting, in Chicago, Illinois, September 29, 2018; and the 57th Annual Scientific Meeting of the Midwestern Association of Plastic Surgeons, in Chicago, Illinois, April 14, 2018.

Disclosure:The authors have no financial interests to disclose in relation to the content of this article. No funding was received for this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

Ahmed M. Afifi, M.D., 600 Highland Avenue, Room G5/361, Madison, Wis. 53792,

Copyright © 2018 by the American Society of Plastic Surgeons