A Case of Mucosal Contact Point Headache Caused by Concha Bullosa

Abstract

Mucosal contact point headache is disease characterized by the occurrence of headache and facial pain triggered by nasal mucosal contact. We report the case of a 45-year-old woman who presented to us with the complaints of left-sided headache and a nasal obstruction on the left side. At her first visit to our hospital, we made the diagnosis of allergic rhinitis and prescribed oral medicines and a nasal spray. However, 2 days later, she presented with recurrent left nasal pain. Sinus CT revealed a huge left concha bullosa that was in contact with the nasal septum. We placed gauze impregnated with adrenaline and lidocaine at the nasal contact point, which led to significant resolution of the nasal pain and headache. Therefore, the patient was suspected as having mucosal contact point headache. We performed endoscopic nasal surgery and separated the concha bullosa from the nasal septum to avoid contact between the two. After the surgery, both the headache and facial pain disappeared within a week.

The nasal turbinate mucosa often comes in contact with the nasal septum, but rarely does this trigger a headache. The mechanism by which it triggers a headache only in some cases is unknown. There are few reports of this disease yet in the literature, and it cannot be diagnosed unless the physician has a high index of suspicion.

This disease may be overlooked unless an otolaryngologist recognizes it: it is important to suspect this disease in patients complaining of a headache in whom contact between the nasal mucosa and nasal tubinate is recognized.