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The Efficacy of Oxymetazoline in Predicting Nasal Triggers in Migraine Patients
Kristopher Katira MD, Samuel Monebi, Hossein Ansari MD, Ali Totonchi MD
University Hospitals/Metro Health Plastic Surgery Residency
2015-03-14
Presenter: Kristopher Katira, MD
Affidavit:
100%
Director Name: Hooman Soltanian MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
As Botox® and lidocaine injections have been used along side constellation of symptoms to confirm migraine trigger sites in the frontal, temporal, and occipital regions, administration of topical oxymetazoline to migraineurs with rhinogenic symptoms may help to identify those with correctable nasal triggers, such as septal contact points. In this study, we report the results of using oxymetazoline in a series of patients.
Methods:
Patients in an established headache practice (HA) were identified as having a potential nasal trigger based on a rhinogenic migraine constellation of symptoms. These patients were instructed to use oxymetazoline after migraine onset, and their response was correlated with available CT images.
Results:
16 patients met inclusion criteria. 13 responded to oxymetazoline (82%), while 3 did not. 12 patients had CT sinus imaging. Of the 9 responders with CT, all 9 had at least 1 identifiable contact point involving septum. Unlike the responders, non-responders had either isolated bone-bone contact points (2 patients) or no contact points (1 patients) on CT. So far, 2 responders have undergone septoplasty by AT and are migraine-free at 6 and 9 months post-op.
Conclusion:
Oxymetazoline can be used with constellation of symptoms to identify migraine surgery candidates with nasal triggers. Non-responders with isolated bone-bone contact points may still benefit from surgery based on constellation of symptoms alone. Further studies, ideally of the prospective, randomized design with post-operative follow up, are needed.
