Nasal surgery to relieve obstructed breathing can reduce or eliminate chronic headaches in selected patients, reports a paper in the December issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Eighty-five percent of patients undergoing functional nasal surgery had at least partial improvement in their headaches, according to a research summary and update by Ahmed M. Afifi, MD, and colleagues of University of Wisconsin, Madison. They write, “These results suggest that the use of nasal surgery to improve headache symptoms is a viable treatment option in appropriately selected chronic headache patients.”
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This paper is important and a significant reminder to all physicians that evaluation of airflow through the nose is an important part of the work-up for headache. While not all patients with headache have scan-confirmed sinusitis, experience has taught us that ” as the nose goes, so go the sinuses”. A “sinus headache” may be the manfestation of imperfect nasal air flow. As the paper pointed out, if nasal obstruction is detected on examination of the patient with chronic headache, there should follow further evaluation and discussion re the possibility that surgical correction of the nasal obstruction will relieve the patient of chronic headache. The doctor who suspects that diagnosis will often prove to be a hero.
Robert Kotler, MD, FACS