Nasal Surgery & Headaches I

Contact Point Headache / “Sinus Headache”

More times than not we get asked whether to cure the problem of various headaches or “sinus headache” problems with nasal surgery.  Many times the answer is no – unfortunately a lot of “sinus headaches” do not involve the sinuses and all – they are caused by some other disturbance of the Trigeminal nerve which has its nerve endings distributed just about everywhere in the head (the eyes, teeth, skin, jaw muscles, and even the brain’s lining).

However, many headache pain or sinus pain problems can be cured with sinus surgeries or office procedures.

Sluder headache, or contact point headache, is one such problem.  This is a common headache or “facial ache” or “sinus ache” that usually affects just one of the face, usually just beneath the eye or sometimes just between the eyes, and notably seems to get worse whenever the nose or sinuses are swollen (such as from allergies).  Patients with Sluder headache often have worsened pain from sinus infections than expected.  Many of these patients also will have stinging pain from nasal steroids or saline rinses (which had been recommend to help with the problem somewhere along the way).

Sluder headache is one of many issues that is though to arise in the sphenopalatine nerve ganglion on the posterior nasal sidewall.  Problems in this area can lead to headaches, watery nasal drip or even excessive dryness, and sometimes a certain kind of headache known as Cluster Headache.

The image above is that of a patient with a badly deviated septum whose main complaint was recurring pain and pressure below the eye.  Antibiotics were often given for presumed sinus infections, but full ENT evaluation only showed a deviated septum.  He was told multiple times that sinus surgery was not needed because “the infection was cured” after a CT scan was reviewed.

However in this case the headaches were typical for Sluder Syndrome.  The severely deviated leftward septum was contacting the sidewall of the nose and irritating the sphenopalatine nerve endings.  After evaluation I recommended the patient for a simple septoplasty procedure.

At 4 days following surgery the headache pain was mostly resolved.  By 6 weeks it was clear the headaches were gone.

G. Aaron Rogers, MD FACS