Headache.

Just the word causes many people, mostly women, to cringe. The 30 million unfortunates who suffer from this jack-hammering, head-splitting pain know too well the effect it has on their lives.

What if you didn't have to take to a darkened room or cancel yet another evening out? What if a simple, 30-minute procedure could relieve or lessen the pain?

"Migraine-strength headaches, which are severe on a daily or frequent basis, have several causes," says Dr. Kevin R. Smith, an otolaryngologist and facial plastic surgeon.

He treats one of the culprits of migraine imposters: the deviated septum. The shifted position of the wall-like structure that separates the two nasal passages creates bone spurs, which can cause severe headaches.

Approximately 18 percent of all adult women and 7 percent of men are afflicted with severe headaches. The cost to society in the US from headaches is $20-$30 billion from missed work hours, reduced productivity and medical services.

"Most of the patients I see have been misdiagnosed as having migraines. They have suffered for an average of eight to 10 years, unaware that the cause existed inside the nose," Smith says.

Migraine, a type of headache that involves constriction of arteries that carry blood to the head, is the word most commonly associated with severe head pain. "My goal is to educate the medical community and general public that in some cases there is a simple explanation of what they believe are migraines. I believe that approximately 10 to 15 percent of the people who suffer from migraines may actually have deviated septums," he says.

Among that percentage is 16-year-old Ara Griffith, who has had severe headaches most of her life. At age 10, her headaches worsened and were diagnosed by a neurologist as migraines.

"A good week meant one migraine and a bad week was at least three," says Tom Griffith, her father. "When she began missing school because of the pain, the doctor put her on stronger medications. Being concerned parents, we just kept searching for an answer."

During an internet search six months ago, Griffith found Smith, assistant clinical professor in the Department of Otolaryngology - Head and Neck Surgery at The University of Texas Medical School at Houston .

After examining Ara, Smith told her parents that he believed she was among those whose headaches were caused by a deviated septum. Ara had surgery in July 2004 and has not had a headache since.

Nose Renovation

The nose brings warm, humidified air into the lungs. Our ability to breathe well depends on the nasal septum, which divides the inside of the breathing passages.  Also important are the nasal turbinates. These big scrolls of bone and tissue contain large blood vessels that swell in response to colds, allergies, weather changes, etc. To breathe freely, the septum must be straight and the turbinates of normal size.

A deviated septum can happen in many ways.  It is either a structural feature you inherit or, most likely, is a result of trauma to the nose. Bicycle falls, fistfights, sports injuries or being in a car wreck can produce a deviated septum.

"Trauma can happen at birth when the baby's nose is pressed against the mother's sacrum for minutes to hours. Imagine what this could do to those soft nose bones," says Smith. The cartilage in the nose is thinner than paper. As the child grows, the external nose and the internal septum grow out of line, and a spur can develop, he explains.

"That spur is the key to the migraine-type headaches a person experiences," Smith explains.

Triggers of headaches involving septal spurs can be anything that causes the nasal cavity membranes to swell:

• Hormones
• Environmental changes such as ozone or weather
• Colds, flu, upper respiratory infections
• Allergies to food and beverages
• Environmental allergies such as mold, dust, animal dander

Women who suffer headaches during their menstrual cycles do so because of hormonal imbalances which lead to fluid retention. This stimulates the turbinates to become engorged and push against a septal spur or deviation. This same mechanism can occur during pregnancy.

Resultant swelling of the turbinates puts pressure against a bone spur, causing pain in the forehead, eye area, nose and cheek regions. It also can cause referred pain in the temples and top of the head, Smith says.

Dozens of varieties of headaches can cause severe pain. Before a septal spur diagnosis can be made, the patient should have a thorough nasal exam by an otolaryngologist (or ENT--ear, nose and throat), a physician who specializes in head and neck disorders.

First, Smith uses a topical decongestant spray to obtain a clear view of the entire nasal airway. If a spur is not obvious, Smith recommends a CAT scan of the sinuses, which gives a more complete picture. This method of examining the body's soft tissues can also identify other subtle contact points within the nose that may cause headaches.

If there appears to be a problematic spur, the surgical procedure to remove it is called a septoplasty. A small incision is made in the nostril, and the mucous membrane is elevated off of the septum. The spur is removed, relieving the pressure point. The turbinates can be repositioned to eliminate any other contact points with the septum. Also, they can be trimmed to allow for improved breathing, especially if congestion is a major problem.

Septoplasty is a relatively simple procedure and takes about 30 minutes.

Smith says that of the percentage of patients with septal bone spur headaches, a review of his practice over the last 11 years showed a cure rate of 40 percent. "Fifty-two percent had improvement of their headaches, which meant fewer attacks or less severe, and only 8 percent had no change," Smith says.

For the Griffiths , deviated septum repair may become a family activity.

"Our other daughter broke her nose recently in a skating accident," Griffith says. "She had never had headaches before. Now she has one every other day. In a few weeks, Dr. Smith will repair her deviated septum. Also, my wife, who has had headaches since she was 13 years old, is planning to schedule an appointment, as well."

UPDATED: 12-02-2004

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