title: Endonasal surgery for contact point headaches: a 10-year longitudinal study.
abstract: OBJECTIVE
  Some migraine and cluster headaches may be triggered by stimulation of intranasal contact points via the trigeminovascular system. Endonasal surgery is successful in some patients, but long-term outcomes have not been reported.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  This investigation included 20 patients with a mean 18-year history of refractory cluster or migraine headaches who were selected for surgery. All had endoscopically visible endonasal contact as well as a positive preoperative cocaine test result. Changes in pain severity and frequency and duration of headache attacks were statistically rated using a MANOVA. Follow-up averaged 112 months.
  
  
  RESULTS
  Almost 10 years after surgery, six patients remained completely free of pain, seven had significant symptom improvement, and seven received no benefit from surgery (65% improvement). Two patients had been free of all symptoms for 7 and 8 years, respectively, before complaints returned.
  
  
  CONCLUSIONS
  Our data suggest that some patients with refractory headaches and endonasal contact areas benefit from surgery, thereby supporting the existence of a connection between the two. Even though it is clear that surgery should be considered only if all other treatments have failed, a success rate of 65% over almost 10 years justifies evaluation of this option. Preoperative patient selection remains crucial and warrants further investigation.
authors.affiliation: Department of Otorhinolaryngology, University of Basel, Kantonsspital, Petersgraben 4, CH-4031 Basel, Switzerland. awelge@uhbs.ch
authors.forename: Antje
authors.initials: A
authors.lastname: Welge-Luessen
authors.forename: Rolf
authors.initials: R
authors.lastname: Hauser
authors.forename: Nevenka
authors.initials: N
authors.lastname: Schmid
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kappos
authors.forename: Rudolf
authors.initials: R
authors.lastname: Probst
mesh_terms: D000328:Adult; D000368:Aged; D003027:Cluster Headache / Q000209:etiology / Q000601:surgery*; D005004:Ethmoid Bone / Q000601:surgery; D005005:Ethmoid Sinus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery; D009666:Nose / Q000601:surgery*; D018579:Patient Selection; D011446:Prospective Studies; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery