鼻腔黏膜接触点性头痛29例临床分析

目的 分析鼻腔黏膜接触点性头痛患者的临床特点及应用鼻内镜手术治疗的效果.方法 南方医科大学珠江医院耳鼻咽喉头颈外科自2008年10月至2010年5月诊治29例鼻腔黏膜接触点性头痛患者,采用鼻内镜检查和鼻窦高分辨率CT三维影像评估鼻腔解剖异常,并通过鼻内镜手术矫治鼻腔解剖异常,随访1年以上后观察患者头痛频率、持续时间及强度的变化.结果 产生鼻腔黏膜接触点的主要解剖异常包括鼻中隔偏曲压迫中鼻甲、下鼻甲,钩突变异压迫中鼻甲或筛泡,以及泡状中鼻甲、中鼻甲反向弯曲、筛泡过度气化.与术前比较,术后患者头痛发作频率减少,平均持续时间缩短,VAS评分降低,差异均有统计学意义(P<0.05).19例患者术后疼痛改善,其中8例疼痛症状完全消失未复发,10例患者较术前无变化,总体有效率为65.52%(19/29).结论 鼻腔结构异常产生的鼻腔黏膜接触点与头痛发病之间存在关联,鼻内镜手术治疗有效,但接触点部位不同,手术疗效亦有差别.

Abstract：

Objective To investigate the intranasal anatomic abnormalities and clinical features of mucosal contact point headache, as well as the outcomes of endoscopic surgery. Methods The clinical data of 29 patients with mucosal contact point headache, received treatment in our hospital from October 2008 and May 2010, were reviewed retrospectively. All cases received CT scans, endoscope examinations and local anesthesia tests. Endoscopic surgery was performed to correct the contact points for these cases. They were followed-up for at least 1 year; and the changes of intensity, duration and frequency of headache of these patients were observed. Results Most common anatomic abnormalities included septal spurs in contact with the turbinates, uncinate process hypertrophy,pneumatized middle turbinates, abnormal curve of middle turbinate and large ethmoid bulla. The intensity, duration and frequency of headache after surgery decreased significantly as compared with those before the surgery (P<0.05). Nineteen of the 29 patients (65.52%) got benefits from surgical intervention, and 8 patients (27.59%) had complete relief of headache. Pain was the same as before the surgery in 10 cases (34.48%) in the follow-up period. Conclusion Intranasal contact points must be considered in patients who have no other obvious cause of headache. Significant relief of headache can be obtained by endoscopic surgery in selected cases.

Nasal mucosal contact point headache: a clinical analysis of 29 cases

Objective To investigate the intranasal anatomic abnormalities and clinical features of mucosal contact point headache, as well as the outcomes of endoscopic surgery. Methods The clinical data of 29 patients with mucosal contact point headache, received treatment in our hospital from October 2008 and May 2010, were reviewed retrospectively. All cases received CT scans, endoscope examinations and local anesthesia tests. Endoscopic surgery was performed to correct the contact points for these cases. They were followed-up for at least 1 year; and the changes of intensity, duration and frequency of headache of these patients were observed. Results Most common anatomic abnormalities included septal spurs in contact with the turbinates, uncinate process hypertrophy,pneumatized middle turbinates, abnormal curve of middle turbinate and large ethmoid bulla. The intensity, duration and frequency of headache after surgery decreased significantly as compared with those before the surgery (P<0.05). Nineteen of the 29 patients (65.52%) got benefits from surgical intervention, and 8 patients (27.59%) had complete relief of headache. Pain was the same as before the surgery in 10 cases (34.48%) in the follow-up period. Conclusion Intranasal contact points must be considered in patients who have no other obvious cause of headache. Significant relief of headache can be obtained by endoscopic surgery in selected cases.