Migraine headache pain originating from the nose is usually located behind the eyes and radiates to one side of the head, is sensitive to hormonal and atmospheric pressure changes, can be associated with rhinorrhea and nasal blockage .
The most common pathology found intranasally is a reverse C-shaped septal deviation with a spur and contact between the turbinates and septum, and presence of a concha bullosa of the middle turbinate, which is often found to be significantly larger and thicker than usual .
Perinasal CT images may reveal septal deviation with spur, contact between the septum and turbinates, concha bullosa, bulla ethmoidalis, prolonged processes uncinatus maxillary sinuses and Haller’s cell, with or without a varying degree of sinusitis. Rarely sphenoid and frontal sinusitis can cause headache in the back of the head and in the forehead respectively
The surgical treatment will include septoplasty, turbinectomy, and decompression of concha bullosa, ethmoidectomy and resection of processes uncinatus maxillary sinuses ,and if pathology found in sphenoid or frontal sinuses then they will be also opened using FESS (functional endoscopic sinus surgery ).
success rate of treatment is above 90%
As conclusion, every patient with migraine headache should be cleared from not having rhinogenic(nasal) trigger that can be easily treated surgically , before committing him with long term medical treatment .