The question of whether a deviated septum (DS) can cause headaches is a common one. A deviated septum is a crooked wall of cartilage and bone that divides the nasal passages. While septal deviations are extremely common, the direct link to headaches is frequently misunderstood. For most people, a deviated septum is an incidental finding rather than the source of head pain.
Understanding Deviated Septum and Nasal Anatomy
The nasal septum is the central structure composed of cartilage in the front and bone toward the back. This wall separates the right and left nasal cavities and regulates airflow, ensuring proper nasal breathing.
A deviation occurs when this dividing wall is significantly shifted away from the midline, making one nasal passage smaller than the other. While minor deviations are present in most adults, a substantial displacement can lead to physical symptoms. Common issues caused by a severe deviation include difficulty breathing, frequent sinus infections due to impaired drainage, and noisy breathing at night. These symptoms arise from the physical obstruction of airflow and the blocking of sinus openings.
The Connection to Headaches: Separating Clinical Consensus from Patient Experience
The vast majority of headaches experienced by people with a deviated septum are primary headaches, such as migraines or tension headaches, which are unrelated to the nasal structure. Clinicians recognize that a deviated septum is present in an estimated 80% of the population, yet only a small fraction suffer from headaches caused by it. Physicians must first rule out all other common causes of head pain before attributing it to a nasal structure.
A deviated septum can, in some cases, increase the risk of headaches indirectly, such as by causing recurrent sinus infections. When a severe deviation blocks the sinus drainage pathways, the resulting inflammation and pressure can lead to a type of pain known as a sinus headache. This pain is caused by the infection, however, not directly by the deviation itself.
How a Deviated Septum May Trigger Pain
When a deviated septum is the direct cause of pain, it is referred to as a “rhinogenic headache,” sometimes called a “contact point headache.” This pain is triggered by a specific anatomical mechanism known as the Contact Point Theory. The theory posits that deviated cartilage or a bony spur on the septum physically touches the sensitive mucosal lining of the lateral nasal wall, often the turbinates.
This constant mechanical pressure irritates the sensory nerve endings in the nasal mucosa. These nerve endings are part of the trigeminal nerve system, which innervates the face and parts of the skull. The irritation at the contact point causes referred pain, where the discomfort is felt elsewhere, commonly in the forehead, around the eye, or in the temple area.
Diagnosis and Resolution
A patient suspected of having a rhinogenic headache undergoes a targeted diagnostic process to confirm the nasal origin of the pain. The initial step involves a physical examination using a nasal endoscope to visually confirm the presence of a mucosal contact point between the septum and the lateral wall. A Computed Tomography (CT) scan is often used to get a detailed, cross-sectional view of the nasal and sinus anatomy, further confirming the location of the contact.
The most definitive test for a rhinogenic headache is the localized anesthetic challenge, often called the Lidocaine test. A physician applies a topical anesthetic, such as lidocaine, directly to the mucosal contact point. If the patient experiences significant, temporary relief from their headache—typically a reduction in pain of 50% or more—it strongly suggests the deviated septum is the source of the pain. The primary resolution for a confirmed rhinogenic headache is a surgical procedure called a septoplasty. By surgically straightening the deviated septum and removing the contact point, the mechanical irritation is eliminated, which has been shown to provide complete or significant relief in a high percentage of carefully selected patients.