Intra-Nasal Trigger Point Injections for Facial Headache

Do you suffer from a stabbing headache in the areas denoted in red? Do these headaches seemingly come out of nowhere one day? Perhaps started after a viral upper respiratory infection?

You may be suffering from a condition known as contact point headache or a type of neuralgia involving one of the nerve plexuses found inside the nose:

• Anterior ethmoid neuralgia (Sluder's neuralgia)
• Sphenopalatine ganglion neuralgia (Pterygopalatine ganglion neuralgia)

This type of headache has often been confused with cluster headache, migraine without aura, sinusitis, or other undefinable pathology especially since CT scans and MRI scans that are obtained often do not reveal any tumor or presence of infection.

In the event of a contact point headache, surgical removal of the offending anatomic abnormality is curative.

However, for neuralgia, trigger point injections may be helpful according to a recent study. Using a 1:1 mixture of 0.5% bupivacaine and Kenalog-40, either the sphenopalatine ganglion or the anterior ethmoid neurovascular bundle or even both are injected. For the sphenopalatine ganglion, the injection is where the middle turbinate inserts into the lateral nasal wall. For anterior ethmoid injection, identify the arch where the middle turbinate inserts superiorly to the lateral nasal wall and inject 5mm above this site.

In a total of 882 nerve blocks in 147 patients, 99.3% had no complications. 2 patients reported visual changes that resolved within 2 days. More importantly, 81.3% claimed improvement in their headache, 17.9% reported no change and 0.79% reported worse pain after the injection.

The typical duration of pain relief was 3-4 weeks. As such, for continued pain relief, the injection needs to be repeated monthly on average.

Reference:
Endoscopic neural blockade for rhinogenic headache and facial pain: 2011 update. Int Forum Allergy Rhinol. 2012 Apr 5. doi: 10.1002/alr.21035. [Epub ahead of print]

Barometric Sinus Headache

MSNBC published a story on April 26, 2012 regarding headaches that come and go with pressure changes such as when flying in an airplane.

The neurological researchers call it "airplane headache" and the story makes it sound like a newly discovered headache, but in actuality, it is something that has been known for a very long time.

Human sinus cavities are air-filled cavities. When outside pressure changes relative to the air pressure within the sinus cavity, air pressure literally increases or decreases within the sinus cavity which a patient may perceive as pain/pressure over the face. This barometric sinus pressure would occur ONLY if the sinuses are clogged shut. If they are open, no problems would occur.

This phenomenon is analogous to a balloon (sinus cavity) that increases in size with decreasing pressure (going up a mountain or ascending in a plane) or decreases in size with increasing pressure (going down a mountain or descending in a plane).

As such, just like the MSNBC story suggests, the principal way to prevent such barometric sinus headache is to take a medication that prevents sinuses from clogging shut. One of the most effective medication is afrin nasal decongestant nasal sprayto be used 30-60 minutes before ascent and descent.

If this issue is a persistent chronic problem, surgical procedures such as balloon sinuplasty can be performed to make the sinus openings larger to decrease the chance of closure from mucosal edema.

Akin to barometric sinus pressure, the ears undergo a similar process which is why people "pop" the ears with pressure changes.

The ear equivalent of a barometric sinus headache is eustachian tube dysfunction.

Source:
Is flying giving you an 'airplane headache'? MSNBC 4/26/12

Stabbing Headache Around Eye or Cheek

Do you suffer from a stabbing headache in the areas denoted in red? Do these headaches seemingly come out of nowhere one day? Perhaps started after a viral upper respiratory infection?

You may be suffering from a condition known as contact point headache. This type of headache is also known as:

• Sluder's neuralgia
• Anterior ethmoid neuralgia
• Sphenopalatine ganglion neuralgia
• Pterygopalatine ganglion neuralgia

This type of headache has often been confused with cluster headache, migraine without aura, sinusitis, or other undefinable pathology especially since CT scans and MRI scans that are obtained often do not reveal any tumor or presence of infection.

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