A deviated septum is a common anatomical variation where the thin wall of bone and cartilage (the nasal septum) is displaced away from the center of the nasal cavity. This displacement causes one nasal passage to be smaller than the other, which can restrict airflow. While most people have some degree of septal deviation, most do not experience symptoms. A pronounced deviation can lead to chronic breathing difficulties and, potentially, headaches.
The Relationship Between Septal Deviation and Head Pain
Although a deviated septum is not typically a primary cause of common headache types like migraines, a specific link exists between septal variation and head pain. This connection is recognized in medical literature, particularly among otolaryngologists, and is often termed a “rhinogenic headache” or “contact point headache.” The pain is directly related to the nasal structure rather than a generalized neurological condition.
This head pain frequently localizes to the face or forehead, often on the same side as the most severe septal deviation. The pain originates from physical contact between the septum and other sensitive structures within the nasal cavity. Successful treatment of the anatomical issue often relieves the associated head pain for certain patients.
Understanding the Mechanism of Septum-Related Headaches
Rhinogenic headaches occur when the displaced septum presses directly against the sensitive lining of the lateral nasal wall or the turbinates. This sustained physical pressure creates a “contact point” between the mucosal surfaces. The nasal mucosa is supplied with sensory fibers from the trigeminal nerve, the fifth cranial nerve responsible for sensation in the face.
Chronic mechanical stimulation at the contact point triggers the trigeminal nerve endings. This irritation sends pain signals that the brain interprets as referred pain in the forehead, face, or around the eyes, following the nerve’s distribution. Inflammation or congestion, such as from allergies or a cold, can worsen the irritation by increasing the pressure exerted at the contact point.
Associated Symptoms and When to Seek Medical Attention
The headache is often one symptom among several issues suggesting a significant septal deviation. The primary complaint is chronic nasal obstruction, which is often worse on one side due to the physical narrowing of the passage. This blockage can force mouth breathing, leading to a dry mouth, especially at night.
Other associated symptoms include frequent nosebleeds, or epistaxis, because the altered airflow can dry out the mucosal surface of the septum. Patients might also experience facial pain or pressure, or loud breathing and snoring during sleep. If these symptoms—including a blocked nostril that does not clear up with standard treatment, frequent nosebleeds, or chronic facial pain—persist and affect quality of life, a consultation with a healthcare professional is warranted. An ear, nose, and throat specialist (otolaryngologist) is the appropriate expert for further evaluation.
Diagnosis and Treatment Options
Diagnosis begins with a thorough physical examination of the nasal passages. A healthcare provider will use a bright light and a nasal speculum to gently open the nostril and visualize the front part of the septum. To inspect deeper into the nasal cavity and sinuses, a small, lighted tube called an endoscope may be used.
Imaging, typically a Computed Tomography (CT) scan of the sinuses, is often necessary to accurately assess the extent of the deviation and rule out other contributing factors, like chronic sinusitis. The CT scan provides detailed images of the bone and cartilage structure, which helps confirm the presence of a contact point between the septum and other structures. This imaging is particularly important when evaluating potential rhinogenic headaches.
Treatment depends on the severity of the symptoms, with non-surgical options explored first for mild cases. Medications such as nasal steroid sprays or decongestants can be used to reduce inflammation and swelling within the nasal lining. Reducing this inflammation can sometimes decrease the pressure at the contact point, thereby alleviating the headache.
For severe deviations or symptoms that do not respond to medication, the definitive treatment is a surgical procedure called septoplasty. Septoplasty is performed to straighten the nasal septum and reposition it in the center of the nasal cavity. The procedure is primarily intended to improve breathing and nasal airflow. If the headaches are confirmed to be rhinogenic in origin, the septoplasty often resolves the pain by eliminating the physical contact point.