What is a Contact Point Headache?
Contact point headache is a rare subtype of headache which also goes by the names of "anterior ethmoidal neuralgia," "Sluder's neuralgia," "sphenopalatine ganglion neuralgia" and "pterygopalatine ganglion neuralgia." Contact point headache is an extremely frustrating headache, as it causes great anguish and suffering in many patients. Contact point headache presents as a persistent stabbing or sharp pain in a single localized area/spot on the face. Often the patient will go many years without diagnosis of this headache and without treating it.
Many patients visit a number of ENTs, neurologists, dentists, spine specialists, oral surgeons, all in avail without any resolution of the pain. Commonly tried and tested medications for contact point headache include nasal sprays, antibiotics, neuropathy medications, narcotics, steroids, muscle relaxants, etc. All these medicines fail to provide relief from contact point headache. The only single medication which works best in providing relief of contact point headache is an over-the-counter decongestant, such as Sudafed. Investigations such as CT scan and MRI do not reveal any sinus infection or tumor. Most of the times, the patient is told that this headache is a result of a psychological issue or is a very bad type of neuropathy.
The cause of this contact point headache is nerve compression due to structural abnormalities, which can be corrected surgically.
Signs & Symptoms of Contact Point Headache
- Commonly the symptoms of pain associated with contact point headache starts after the patient has had an upper respiratory infection.
- It is felt as a localized pain on one spot and one side of the face.
- The pain can also be localized to the roof of the mouth and the upper teeth.
- Classically the symptoms of pain associated with contact point headache is localized to the area between the nose and the eye or the cheek; however, the pain can also radiate to other parts of the face.
- The quality of the pain is sharp, shooting or stabbing pain. Rarely, it can be felt as a pressure sensation type of pain.
- The pain of the contact point headache can also be related to noise and light sensitivity and can be misdiagnosed as migraines without an aura (MWOA).
- OTC decongestants help best in relieving the headache; however, their effect is only temporary.
Causes of Contact Point Headache
- There is compression of the nerve between two structures in an anatomic spot present inside the nose.
- The nerve pinching is same as that of the sciatica, but it occurs in the nose/face causing Contact Point Headache.
- The pinched nerve can either be the anterior ethmoid nerve or a nerve which branches off sphenopalatine ganglion (pterygopalatine ganglion). Patient suffering from
- Contact Point Headache feels pain in the regions where the nerve gets pinched.
- In patients, who have contact point headache with additional symptoms of gum pain or upper teeth pain along with odd sensations of the roof of the mouth there is commonly sphenopalatine ganglion involvement; however, the anterior ethmoid nerve is not involved.
- Septal spur or a deviated septum is the main culprit for Contact Point Headache, which causes nerve compression where it digs or juts into the middle or superior turbinate of the nose. It can be thought of as a bunion in the nose.
- The septum is a wall which is supposed to be straight and divides the nose into right and left nasal cavities. When this nasal septum becomes deviated, it causes narrowing on one side on the nose. If it is severe with nasal mucosal swelling, it can press into the lateral nasal wall where the superior and middle turbinates are present, resulting in a pinpoint headache.
- Other than the septum, possible structures which can also cause nerve compression resulting in contact point headaches include concha bullosa or abnormal position of the turbinates.
Investigations to Diagnose Contact Point Headache
To confirm the diagnosis of contact point headaches, the following workup needs to be done:
- ENT evaluation such as nasal endoscopy to confirm the presence of a structural problem.
- CT scan of the sinus cavity is an important test to ensure that there are no underlying anatomic bony irregularities or sinus pathology.
- CT scan of the neck can also be done if there is neuropathy of the sphenopalatine ganglion nerve along with endoscopic suggestion of a possible tumor at the base of the skull.
- MRI scan can be ordered by a neurologist to exclude any underlying brain/spinal pathology.
- Depending on the finding of the CT scan and nasal endoscopy, there is a diagnostic test which can be done where nasal endoscope "touches" the contact point area in order to see if it exacerbates or reproduces the contact point headache. Then there is a follow-up test done where a numbing medicine is applied to the region of the contact point to see if it alleviates the pain.
Treatment for Contact Point Headache
- As the cause of contact point headache is a structural problem, so there is no pill or nasal spray which can provide a "cure" for this problem as a pill cannot fix a broken bone or tissue.
- Temporary relief from Contact Point Headache can be achieved with the use of decongestants and nasal sprays for up to some hours to a few days. These medications help in reducing the mucosal swelling, if present, and create more room which helps in relieving the nerve compression. However, when the mucosal swelling recurs, the pain also returns.
- So, surgery is the only treatment which can address the root cause of Contact Point Headache by rectifying the abnormal anatomic structures, which are causing the nerve compression. Surgical treatment for Contact Point Headache commonly involves removing the septal spur or straightening the deviated nasal septum, whichever is the source of nerve pinching.
- Rarely sinus surgery can also be needed.
- The aim of the treatment for Contact Point Headache is to create as much room as possible so as to avoid any compression of the nerve when there is mucosal swelling.
- Less invasive options to treat Contact Point Headache can be considered in some rare cases, such as injections, which can, however, provide only temporary relief for some weeks to a few months.
- There is no clear-cut answer as to why the patient experiences a contact point headache after some years of presence of structural abnormalities, such as deviated septum or septal spur. The cause could be neuropathy due to hypersensitization of a nerve during a viral upper respiratory infection. So, with this neuropathy, any type of physical irritation of the nerve, such as physical compression causes pain or contact point headache. However, this is just an educated guess.
- In case the patient does not have any anatomic abnormalities, then the chances of having a contact point headache are very less. Differential diagnosis includes dental problems, cluster headache, atypical migraine, trigeminal migraine, trigeminal neuralgia or a true sphenopalatine ganglion neuralgia which does not have a physical problem.
- There can also be a sino-nasal physical problem for the headache, which can be resolved with surgical treatment. Patient can also be referred to a neurologist.