Skip to main content

Role of endoscopy in rhinogenic contact headache not responding to medical treatment



To assess the role of various anatomical variation of the nose in the pathogenesis of contact point rhinogenic headache of noninfective or organic cause and to evaluate the role of endoscopic surgery with removal or correction of the anatomical variation that caused headache in the management.

Patients and methods

This study included 30 patients with refractory or resistant headache for more than 1 year and diagnosed to have sinonasal anatomical variations. They were presented to the outpatient clinics of Al-Zahraa University Hospital in the period from May 2015 to May 2018. There ages ranged from 18 to 34 years. A total of 20 (66.7%) patients were males and 10 (33.3%) were females. Data from this group were analyzed retrospectively.


Multiple anatomical variations were noted by endoscopy and computed tomographic scans in 30 patients. These variations included septum deviation in 30 (100%) patients followed by hypertrophied inferior turbinate in 15 (50%) patients then concha bullosa in 14 (46.7%) patients. In these 30 patients, 25 (83.3%) cases showed complete cure, three (10%) cases showed improvement, whereas two (6.7%) cases were unsatisfied.


Minor intranasal anatomical variations or hidden infection may be the cause of primary headache misdiagnosed as a headache of unknown etiology. The functional endoscopic sinus surgery had succeeded in eliminating or significantly reducing headache attacks.


  1. 1

    Stackpole SA, Eldelstein DR. Anatomic variant of paranasal sinus and their implication for sinusitis. Curr Op Otolaryngol Head Neck Surg 2014; 4:1–6.

    Google Scholar 

  2. 2

    Stammberger H. Functional endoscopic sinus surgery. Philadelphia: BC Decker; 1991.

    Google Scholar 

  3. 3

    Hsueh-Hsin S, Chiche H, Shiang F. Non sinusitis-related rhinogenic headache: a ten-year experience. Am J Outolarygol Head Neck Med Surg 2012; 29:326–332.

    Google Scholar 

  4. 4

    Devrim B, Zekeriya A, Nurettin A, Refik C. Surgical outcomes for rhinogenic contact point headaches. Med PrincPract 2011; 20:29–33.

    Google Scholar 

  5. 5

    Landrigan GP, Kirkpatrick DA. Intra nasal xylocaine:aprognostic aid for pre-operative assessment of facial pain of nasal origin. J Otolaryngol 2012; 21:126–128.

    Google Scholar 

  6. 6

    Behim F, Behin B, Behin D. Surgical management of contact point headache. Headache 2011; 45:204–210.

    Article  Google Scholar 

  7. 7

    Low WK, Willatt DT. Headache associated with nasal obstruction due to deviated septum. Headache 1995; 35:404–406.

    Article  CAS  Google Scholar 

  8. 8

    Clerico DM. Rhinopathic headaches: referred pain of nasal and sinus origin. In: Gershwin ME, Incaudo G, eds. Diseases of the sinuses. Totowa, NJ: Humana Press Inc.; 1996. 403–423

    Google Scholar 

  9. 9

    Karataş D, Yüksel F, Şentürk M, Doğan M. The contribution of computed tomography to nasal septoplasty. J CraniofacSurg 2013; 24:1549–1551.

    Article  Google Scholar 

  10. 10

    Huang HH, Lee TJ, Huang CC, Chang PH, Huang SF. Non- sinusitis related rhinogenous headache: a ten-year experience. Am J Otolaryngol 2008; 29:326–332.

    Article  CAS  Google Scholar 

  11. 11

    Parsons DS, Batra PS. Functional endoscopic sinus surgical outcomes for contact point headaches. Laryngoscope 1998; 108:696–702.

    Article  CAS  Google Scholar 

  12. 12

    Stammberger H, Wolf G. Headache and sinus disease: the endoscopic approach. Ann Otol Rhinol Laryngol 1988; 97 (Suppl. 134):3–23.

    Article  Google Scholar 

  13. 13

    Lidov M, Som P. Inflammatory disease involving a concha bullosa (enlarged pneumatized middle nasal turbinate): MR and CT appearance. Am J Neuroradiol 1990; 11:999–1001.

    PubMed  CAS  Google Scholar 

  14. 14

    Yousem DM, Kennedy DW, Rosenberg S. Ostiomeatal risk factors for sinusitis: CT evaluation. J Otolaryngol 1991; 20:419–424.

    PubMed  CAS  Google Scholar 

  15. 15

    Bolger W, Butzin C, Prason D. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 2009; 101:56–64.

    Google Scholar 

  16. 16

    Greenfield HJ. Headache and facial pain associated with nasal and sinus disorders: a diagnostic and therapeutic challenge.Part I. Insights Otolaryngol 1990; 5:2–8.

    Google Scholar 

  17. 17

    Greenfield HJ. Headache and facial pain associated with nasal and sinus disorders: a diagnostic and therapeutic challenge.Part 11: Clinical application. Insights Otolaryngol 1991; 6:2–8.

    Google Scholar 

  18. 18

    John PP. Clinical neuroanatomy, Vol I 16, ed. 6, Scott–Brown’s Otolaryngology 1997.

  19. 19

    Schonsted-Madsen U, Stoksted P, Christensen PH, Koch-Henriksen N. Chronic headache related to nasalobstruction. J Laryngol Otol 1986; 100:165–170.

    Article  CAS  Google Scholar 

  20. 20

    Clerico DM. Sinus headaches reconsidered: referred cephalgia of rhinologic origin masquerading as refractory primary headaches. Headache 1995; 35:185–192.

    Article  CAS  Google Scholar 

  21. 21

    Bonaccorsi P. Primary headaches compared with idiopathic rhinogenic headaches: the actual diagnostic misunderstandings. European Rhinologic Society Annual Meeting, 1988.

Download references

Author information



Corresponding author

Correspondence to Taghreed M. M. Salem Master degree.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kadah, S.M.S., Mokhemar, S.M., Alkholy, T.A.E. et al. Role of endoscopy in rhinogenic contact headache not responding to medical treatment. Egypt J Otolaryngol 35, 256–261 (2019).

Download citation


  • contact headache
  • headache
  • rhinogenic headache