Razi Journal of Medical Sciences

    Background & Aim: Some headaches may originate from sinonasal area and can develop without any inflammation or infection signs. Contact points between lateral nasal walls and the septum may trigger pain via trigeminovascular system. The aim of the present study is to evaluate the role of endonasal endoscopic surgery in the management of sinonasal headaches with special regard for diagnostic criteria and patient's choice. Patients and Method: In this prospective, non-randomized, quasi-experimental study, 36 patients suffering from chronic and refractory headaches were evaluated by examination(rhinoscopy and/or endoscopy), sinus CT scan, anesthetic test and then categorized into four groups according to the diagnostic method. Pain severity prior to and after surgery(with an average follow-up period of 18 months) was assessed by VAS(visual analogus scale) method(0-10 scale) and analyzed by ANOVA. Results: Overall success rate was 83%, including 11% cure and 72% improvement. The best response was noted in patients whose diagnostic criteria were all positive. The response in all patient groups except those who only had positive examination was statistically significant. 39% of the patients had been previously diagnosed with migraine and 78% of them developed improvement. Conclusion: Surgery in cases with more positive evidence of contact points, particularly if medical therapy has failed, could be successful. This issue may be acceptable even in migrainous patients.