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Nasal Pathology in the Migraine Surgery Population: Incidence, Patterns and Predictors of Surgical Success
Michelle Lee, MD, Cameron Erickson, BS, Bahman Guyuron, MD.
Case Western Reserve University, Cleveland, OH, USA.

PURPOSE:
The incidence of nasal pathology in the migraine surgery III (septonasal trigger) patient population is unknown. The purpose of this study is to identify the patterns of nasal pathology in 100 randomly selected migraine surgery III patients and highlight potential correlations with migraine surgery success.
METHODS:
A retrospective review was performed on 100 migraine III patients. Demographics, pre/post migraine surgery symptoms, and pathology seen on preoperative computed tomography (CT) scans were reviewed.
RESULTS:
Twenty percent of patients had preoperative sinus disease. The following pathologies were seen on CT scan: septal deviation (77%), septal spur (33%), concha bullosa (48%), sinus pathology (20%), and intranasal contact points (62%). Compared to CT scans of the general population, the migraine III population had a higher incidence of septal deviation (77% migraine vs 27% general), and concha bullosa (48% migraine vs 25% general). A higher incidence of clinical sinusitis (20% migraine vs. 5-15% general) was also seen. Septoplasty was performed in 87%, and conservative turbinectomy in 60% of patients. Patient who failed surgery (<50% reduction in migraine index) had a significantly higher incidence of contact points (80.7% vs. 55.4%, p=0.016) than successful migraine surgery patients.
CONCLUSION:
The migraine III population has an increased incidence of septal deviation, sinus disease and turbinate abnormality. It is likely that the failure to achieve more successful outcome was the consequence of conservative nasal management and residual contact points due to concern for the development of nasal dryness.


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