Published: 2021-12-24

Rhinogenic contact point headache in pediatric age group: a review

Santosh Kumar Swain, Prasenjit Baliarsingh


Headache is a common clinical entity of pediatric patients in routine clinical practice. Anatomical variation in the nasal cavity may result in headaches due to contact of the opposing mucosal surfaces, called rhinogenic contact point headache (RCPH). RCPH has recently begun to be of interest among clinicians and is accepted as a cause of headache by international headache society classification. The pressure of the two opposing mucosal surfaces in the nasal cavity without any evidence of inflammation can be an etiology for headache or facial pain. Anatomical variations in the nasal cavity like deviated nasal septum (DNS), spur, concha bullosa, hypertrophied inferior turbinate, medialized middle turbinate, and septal bullosa are important causes for contact point headache. RCPH is often misdiagnosed by clinicians during the assessment of headaches in pediatric patients and is sometimes considered a headache of unknown etiology. Endoscopic examination of the nasal cavity and computed tomography (CT) scans are important tools for the diagnosis of anatomical variations in the nasal cavity causing RCPH. Endoscopic resection of the contact point in the nasal cavity is the treatment of choice. There is not much literature for RCPH in pediatric patients, indicating that these clinical entities are neglected. This review article discusses the details of the epidemiology, etiopathology, clinical manifestations, diagnosis, treatment of the RCPH in pediatric patients.


RCPH, Pediatric age, Deviated nasal septum, Septal spur, Middle turbinate concha bullosa

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Swain SK, Mohanty S, Sahu MC. Migraine-related vertigo in an elderly male. Apollo Med. 2018;15(2):112-5.

Philipp J, Zeiler M, Wöber C, Wagner G, Karwautz AF, Steiner TJ et al. Prevalence and burden of headache in children and adolescents in Austria–a nationwide study in a representative sample of pupils aged 10-18 years. J headache pain. 2019 ;20(1):1-2.

Swain SK, Behera IC, Sahoo L. Vestibular migraine: Our experiences at a tertiary care teaching hospital of Eastern India. Med J Dr. DY Patil Vidyapeeth. 2020;13(6):636-41.

Swain SK, Achary S, Das SR. Vertigo in pediatric age: Often challenge to clinicians. Int J Cur Res Rev. 2020;12(18):136-41.

Swain SK, Debta P, Lenka S, Samal S, Dani A, Mahapatra S. Vestibular migraine-A Challenging Clinical Entity. Indian J Forensic Med Toxicol. 2020;14(4):8835-841.

Swain SK, Behera IC, Mohanty S, Sahu MC. Rhinogenic contact point headache-Frequently missed clinical entity. Apollo Med. 2016;13(3):169-73.

Herzallah IR, Hamed MA, Salem SM, Suurna MV. Mucosal contact points and paranasal sinus pneumatization: does radiology predict headache causality? Laryngoscope. 2015;125:2021-6.

Abu-Bakra M, Jones NS. Does stimulation of the nasal mucosa cause refer pain to the face? Clin Otolaryngol Allied Sci. 2001;26:403-32.

Swain SK, Das A, Samal R, Behera IC, Sahu MC. An unusually giant frontoethmoidal mucopyocele in a child-A case report. Pediatria Polska. 2015;90(6):511-4.

Tosun F, Gerek M, Ozkaptan Y. Nasal surgery for contact point headaches. Headache. 2000;40(3):237-40.

Patel ZM, Kennedy DW, Setzen M, Poetker DM, DelGaudio JM. "sinus headache": rhinogenic headache or migraine? An evidence-based guide to diagnosis and treatment. Int Forum Allergy Rhinol. 2013;3(3):221-30.

Roe JO. The frequent dependence of persisted and so-called congestive headaches upon abnormal conditions of the nasal passages. Med Record. 1888;34:200-4.

Kunachak S. Middle turbinate lateralization: a simple treatment for rhinologic headache. Laryngoscope. 2002;112(5):870-2.

Peric A, Baletic N, Sotirovic J. A case of an uncommon anatomic variation of the middle turbinate associated with headache. Acta Otorhinolaryngol Ital. 2010;30(3):156-9.

Swain SK, Das A, Sahu MC. Anatomical variations of nose causing rhinogenic contact point headache-a study at a tertiary care hospital of eastern India. Polish Ann Med. 2018;25(1):51-5.

Swain SK, Debta P, Pradhan S. Rhinoscleroma in a pediatric patient. Apollo Med. 2020 ;17(2):117-9.

Swain SK, Jena A, Sahu MC, Banerjee A. Eagle's Syndrome: Our experiences in a tertiary care teaching hospital of Eastern India. J Head Neck Physicians Surgeons. 2017;5(2):66-70.

Behin F, Behin B, Behin D, Baredes S. Surgical management of contact point headaches. Headache. 2005;45(3):204-10.

Lee HY, Kim CH, Kim JY, Kim JK, Song MH, Yang HJ et al. Surgical anatomy of the middle turbinate. Clin Anatomy. 2006;19(6):493-6.

Braun H, Stammberger H. Pneumatization of turbinates. Laryngoscope. 2003;113:668-72.

Stammberger H, Wolf G. Headaches and sinus disease: the endoscopic approach. Ann Otol Rhinol Laryngol Suppl. 1988;134:3-23.

Behin F, Lipton RB, Bigal M. Migraine and intranasal contact point headache: is there any connection? Curr Pain Headache Rep. 2006;10(4):312-5.

Swain SK, Sahu MC, Banerjee A. Non-sinonasal isolated facio-orbital mucormycosis–a case report. J de mycol med. 2018;28(3):538-41.

Gerbe RW, Fry TL, Fischer ND. Headache of nasal spur origin: an easily diagnosed and surgically correctable cause of facial pain. Headache. 1984;24:329-30.

Swain SK. Middle turbinate concha bullosa and its relationship with chronic sinusitis: a review. Int J Otorhinolaryngol Head Neck Surg. 2021;7(6):1062-67.

Swain SK, Behera IC, Sahu MC. Primary sinonasal tuberculosis: Our experiences in a tertiary care hospital of eastern India. Egypt J Ear, Nose, Throat Allied Sci. 2017;18(3):237-40.

Kalaiarasi R, Ramakrishnan V, Poyyamoli S. Anatomical variations of the middle turbinate concha bullosa and its relationship with chronic sinusitis: a prospective radiologic study. Int arch otorhinolaryngol. 2018;22:297-302.

Albirmawy OA, Elsherif HS, Shehata EM, Younes A. Middle Turbinate Evacuation Conchoplasty in Management of Contact-Point Rhinogenic Headache in Children. Int J Clin Pediatr. 2010;1(4-5):115-23.

Sadeghi M, Saedi B, Ghaderi Y. Endoscopic management of contact point headache in patients resistant to medical treatment. Indian J Otolaryngol Head Neck Surg. 2013;65:415-20.

Swain SK, Sahu MC, Samantray K. An unusual cause of otalgia in a child-a case report. Pediatr Pol. 2016;91:480-3.

Mishra D, Choudhury KK, Gupta A. Headache with autonomic features in a child: cluster headache or contact-point headache? Headache. 2008;48:473-5.

Karatas D, Yuksel F, Senturk M, Dogan M. The contribution of computed tomography to nasal septoplasty. J Craniofac Surg. 2013;24:1549-51.

La Mantia I, Grillo C, Andaloro C. Rhinogenic contact point headache: surgical treatment versus medical treatment. J Craniofac Surg. 2018;29:228-30.

Eyigör H, Eyigör M, Erol B, Selçuk ÖT, Renda L, Yılmaz MD et al. Changes in substance P levels of inferior turbinate in patients with mucosal contact headache. Brazilian j otorhinolaryngol. 2020;86:450-5.

Peric A, Rasic D, Grgurevic U. Surgical treatment of rhinogenic contact point headache: an experience from a tertiary care hospital. Int Arch Otorhinolaryngol. 2016;20:166-71.

Kennedy DW, Zinreich SJ. The functional endoscopic approach to inflammatory sinus disease: Current perspectives and technique modifications. Am J Rhinol. 1988;2:89-96.

Har-el G, Slavit DH. Turbinoplasty for concha bullosa: a non-synechiae-forming alternative to middle turbinectomy. Rhinology. 1996;34(1):54-6.

Huang HH, Lee TJ, Huang CC, Chang PH, Huang SF. Non-sinusitis-related rhinogenous headache: a ten-year experience. Am J Otolaryngol. 2008; 29:326-32.

Chow JM. Rhinologic headaches. Otolaryngol Head Neck Surg. 1994;111:211-8.

Parsons DS, Batra PS. Functional endoscopic sinus surgical outcomes for contact point headaches. Laryngoscope. 1998;108:696-702.