• Antje Welge-Luessen, Rolf Hauser, Nevenka Schmid, Ludwig Kappos, and Rudolf Probst.
• Department of Otorhinolaryngology, University of Basel, Kantonsspital, Petersgraben 4, CH-4031 Basel, Switzerland. awelge@uhbs.ch
• Laryngoscope. 2003 Dec 1; 113 (12): 2151-6.

ObjectiveSome 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.Study DesignProspective.MethodsThis 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.ResultsAlmost 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.ConclusionOur 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.

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