A deviated septum is where the nasal septum is displaced to one side, making one nasal passage significantly smaller than the other. This misalignment alters the normal flow of air through the nose. While minor deviations often cause no symptoms, a severe displacement can lead to problems like nasal congestion and difficulty breathing. The relationship between this structural issue and chronic head discomfort, often manifesting as head pain, requires careful medical investigation.
Is the Deviated Septum a Direct Cause of Headaches?
A deviated septum is not a direct cause of common primary headache disorders, such as migraines or tension-type headaches. These forms of head pain usually stem from neurological or muscular mechanisms unrelated to nasal anatomy. However, a severe deviation can lead to specific types of head pain through secondary mechanisms within the nasal passages.
The head pain that does occur is categorized as a rhinogenic headache, meaning it originates in the nose. This discomfort is secondary to the deviation causing issues like chronic inflammation or contact between internal nasal structures. The pain is generally localized and may respond to medical or surgical treatment aimed at correcting the underlying nasal issue. Establishing a clear diagnosis is important because treating the deviation will not resolve a headache caused by a different neurological mechanism.
How a Septum Deviation Can Lead to Head Pain
A severe deviation can lead to head pain through two main pathways related to the altered anatomy of the nasal cavity.
Mucosal Contact Headaches
The first pathway involves mucosal contact headaches, also known as rhinogenic contact point headaches. This occurs when a bony or cartilaginous spur on the deviated septum presses directly against the sensitive lining (mucosa) of the lateral nasal wall, such as the turbinates.
This constant contact irritates sensory nerves, particularly branches of the trigeminal nerve, which supplies sensation to the face and head. The irritation triggers nerve signals that the brain interprets as pain, often localized to the forehead, periorbital area, or temples. This mechanical stimulation may cause a local release of neuropeptides, contributing to the sensation of head pain.
Sinus Drainage Obstruction
The second mechanism involves the obstruction of the sinuses’ natural drainage pathways. When the deviated septum narrows the nasal passage, it can block the small openings through which the sinuses drain mucus. This blockage leads to the buildup of fluid and pressure within the sinuses, promoting chronic or recurrent sinusitis. Sinusitis-related head pain is felt as a deep, dull ache or pressure sensation across the face, forehead, or around the eyes.
Recognizing Other Symptoms of a Deviated Septum
A deviated septum is more commonly associated with symptoms related to restricted nasal airflow than head pain. The most frequent complaint is nasal congestion, often worse on the side of the deviation, making it difficult to breathe comfortably through the nose.
This persistent blockage often leads to mouth breathing, particularly during sleep, which can contribute to noisy breathing, snoring, and sleep disturbances. The structural change can also dry out the nasal lining, increasing susceptibility to frequent nosebleeds.
Other common non-headache symptoms include facial pain or pressure, which is sometimes mistaken for a sinus infection. Chronic obstruction and mucosal inflammation can also decrease the ability to smell and taste normally.
Medical Evaluation and Corrective Treatment
A medical evaluation for a suspected deviated septum begins with a thorough physical examination of the nasal passages. A specialist, such as an otolaryngologist, uses a nasal speculum and light to visualize the degree of the septal deviation. Nasal endoscopy, which uses a small, lighted camera, may be performed for a more detailed assessment to confirm contact points between the septum and turbinates.
A Computed Tomography (CT) scan is often utilized to assess the extent of the deviation and rule out other causes of head pain. This imaging provides cross-sectional views of the nasal and sinus cavities. It allows the physician to confirm a severe deviation, identify chronic sinus disease, and determine the exact location of any contact points necessary for treatment planning.
Non-Surgical Management
If symptoms are mild or inflammation is the primary issue, non-surgical management is the first approach. This includes nasal steroid sprays to reduce swelling in the nasal lining and relieve mild congestion. Decongestants can offer temporary relief by shrinking tissues, but their use is limited due to the risk of rebound congestion.
Septoplasty
If conservative treatments fail, especially for severe nasal obstruction or confirmed rhinogenic headaches, surgical correction may be recommended. The procedure to straighten the septum is called a septoplasty. During this surgery, the surgeon trims, reshapes, or repositions the cartilage and bone to center the septum in the nasal cavity. The primary goal is to significantly improve nasal airflow, which may resolve secondary issues like chronic congestion and contact-point related head pain.