Functional endoscopic sinus surgery in patients with sinugenic headache.

Sixteen patients were operated on by functional endoscopic sinus surgery. Their principal complaint was facial pain or headache which was thought to be of sinugenic origin. These patients had no osteomeatal complex obstruction on diagnostic nasal endoscopy and also had unremarkable sinus diseases on computed tomography scan of paranasal sinuses. The operative procedures were very limited functional endoscopic sinus surgery which included middle meatotomies with uncinectomies and partial turbinectomies (frontoinferior). Ten patients (62.5%) had no headache postoperatively, and six patients (37.5%) had a reduction in severity. These patients also had a significant reduction in severity of associated nasal symptoms (yellow or green nasal discharge, nasal blockage, postnasal drainage, asthma, allergies). (p < 0.05) The pathophysiologic mechanism of facial pain or headache in these patients is probably related to reversible mucosal disease. This report focuses on a small group of select patients who had specific complaints and had underlying nasal mucosal disease in the form of allergy or vasomotor rhinitis. This therapy is not recommended for every patient, but only a small, selected group of patients who had classic complaints of sinus headache and had had medical treatment failures even if their nasal endoscopy and computed tomography scans were normal.