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Mucosal Contact Point Headache

This headache type contains limited evidence to support it

Diagnostic criteria:
  1. Intermittent pain localized to the periorbital and medial canthal or temporozygomatic regions.
  2. Clinical, nasal endoscopic and/or CT imaging evidence of mucosal contact points without acute rhinosinusitis.
  3. Evidence that the pain can be attributed to mucosal contact based on at least one of the following:
    1. Pain corresponds to gravitational variations in mucosal congestion as the patient moves between upright and recumbent postures. Generally the patient reports pain worse in the morning upon waking which decreases as the day goes on. However, I question this and wonder if in some patients the reverse is true?
    2. Abolition of pain, as in complete relief of pain, within 5 minutes after diagnostic topical application of local anaesthesia to the middle turbinate. This can be done quickly and easily by an Ear, Nose, and Throat Doctor.
  4. Pain resolves within 7 days, and does not recur, after surgical removal of mucosal contact points.

Dr. Todd Rozen suggests that while nasal contact is easy to visualize on a brain MRI, most neuroradiologists do not report it. He personally reviews his patient's imaging studies to look for a possible contact point that was missed that could be causing them a headache. He suggets having an ENT (ear nose and throat doctor) perform a lidocaine blockade of the possible contact point to determine if this temporarily relieves the headache. [4]

1. The International Headache Society. The International Classification of Headache Disorders, 2nd edition. Written 2004.
2. Mayo Clinic. Sinus Headache: A Neurology, Otolarynology, Allergy, and Primary Care Consesus on Diagnosis and Treatment. http://www.mayoclinicproceedings.com/pdf%2F8007%2F8007r3.pdf
3. Douglas Hoffman. A Case of Contact Point Headache? http://www.doctorhoffman.com/sluder.htm
4. Todd D. Rozen. Intranasal contact point headache: Missing the "point" on brain MRI. Neurology. 2009. 27. page 1107.

If the above link for (1) does not work go here http://www.teethremoval.com/ihc_II_main_no_print.pdf

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