Nasal Headache and Endoscopic Nerve Decompression: Causes, Diagnosis and Treatment

Short answer: Some long-standing headaches and facial pains start inside the nose, where a bent septum, a bony spur or a swollen turbinate presses on the lining and its nerves (a "contact point"), or where nerves such as the anterior ethmoidal nerve and sphenopalatine ganglion are irritated (Sluder's neuralgia). These headaches are often labelled migraine or sinus. An ENT can confirm a nasal cause with endoscopy, a CT scan and a numbing test, and when one is found, treatment ranges from medicines to endoscopic surgery done through the nostrils.

Medically reviewed by Dr. Prashanth R. Reddy, ENT Surgeon (MS ENT) · Last reviewed: 19 October 2026

Key takeaways

• Most headaches are migraine or tension-type; a nasal cause is found in a smaller group of people.
• Clues to a nasal cause: one-sided pain around the eye, nose or forehead, a blocked nose on the same side, and pain that worsens with colds, AC or lying down.
• Diagnosis needs a nasal endoscopy, a CT scan and often a numbing (anaesthetic) test, not symptoms alone.
• Endoscopic nerve decompression is done through the nostrils: Zero Cut. Zero Scar. Zero Bandage. It is considered only when tests point to a nasal source and medicines have not helped.

What is a nasal (rhinogenic) headache?

A rhinogenic headache is pain that arises from structures inside the nose rather than from the brain or the muscles of the head. The inside of the nose is richly supplied by branches of the trigeminal nerve, the same nerve that carries most facial and head pain. When two surfaces inside the nose press against each other, or when a nerve is irritated by swelling, the pain can be felt far away, around the eye, forehead, temple or even the back of the head.

The International Classification of Headache Disorders recognises headache attributed to disorders of the nasal mucosa, turbinates or septum, provided there is clear evidence of a nasal lesion and the pain improves when that lesion is treated or numbed.

What conditions fall under nasal headache?

• Contact point headache: a deviated septum or septal spur touching the turbinate or side wall of the nose.
• Sluder's neuralgia (sphenopalatine ganglion neuralgia): one-sided facial pain linked to the nerve hub behind the nose, often with a watery eye or blocked nose. Read more: Sluder's neuralgia: a hidden nasal cause of chronic headache.
• Anterior ethmoidal nerve syndrome: pain between the eyes and over the bridge of the nose from irritation of the anterior ethmoidal neurovascular complex.
• Concha bullosa: an air-filled, enlarged middle turbinate pressing on the septum.
• Chronic sinusitis: pressure headache during flares, always with nasal symptoms. See Can sinusitis cause headache every day?

Sinus headache, migraine or a nasal contact point: how can you tell?

Many people diagnosed with "sinus headache" actually have migraine, and migraine can itself cause a stuffy nose and watery eye. Some patterns help:

• Migraine: throbbing, often with nausea or light sensitivity, episodes lasting hours to days with clear days in between.
• Sinusitis: pressure with thick discharge, blockage or reduced smell, often after a cold.
• Contact point or nerve-related pain: usually one-sided, centred around the eye, nose or forehead, often worse with colds, AC, weather changes or lying on one side, and frequently not fully relieved by migraine medicines.

A headache diary noting the side, timing, triggers and nasal symptoms is very useful before your visit.

How is a nasal cause confirmed?

1. History and examination by an ENT, ideally alongside a neurologist's opinion where migraine is likely.
2. Nasal endoscopy: a thin camera passed gently into the nose after a numbing spray, to see contact points, spurs, polyps or swelling.
3. CT scan of the nose and sinuses: to map the septum, turbinates and sinuses.
4. Diagnostic numbing test: a local anaesthetic applied to the suspected contact point or nerve area. If the headache clearly eases, a nasal source becomes more likely.

What are the treatment options?

Treatment depends on what is found. Many people improve with medical treatment of allergy or swelling, saline rinses and steroid sprays. Where migraine is the main problem, a neurologist's care comes first.

When a clear structural contact point or nerve compression is found, the numbing test is positive and medicines have not helped, endoscopic nerve decompression may be discussed. This can include straightening the septum (septoplasty), removing a spur, reducing or reshaping the turbinates, or relieving pressure on the anterior ethmoidal nerve or sphenopalatine area. It is done entirely through the nostrils with an endoscope: Zero Cut. Zero Scar. Zero Bandage.

Studies of contact point surgery report improvement in many carefully selected patients, but results vary and not everyone becomes headache-free. The decision should be shared between you, your ENT and, where relevant, your neurologist.

What is recovery like after endoscopic nasal surgery?

Most people go home the same day or the next day. Mild blockage and crusting are common for the first one to two weeks, managed with saline rinses and follow-up cleaning. Many return to desk work within about a week. See How long is recovery after sinus surgery?

When should you see an ENT for headaches?

• One-sided headache or facial pain that keeps returning, especially with a blocked nose on the same side.
• "Sinus headache" that has not responded to antibiotics or decongestants.
• Migraine treatment that has helped only partly, with nasal symptoms.

Seek emergency care for a sudden, severe "worst ever" headache, headache with fever and a stiff neck, weakness, confusion, vision loss, or headache after a head injury.

Frequently asked questions

Can a deviated septum cause headaches? It can in some people, when a spur or bend presses on the side wall of the nose or blocks sinus drainage. A deviated septum is common, so it must be shown to be the cause before treating it.

Is nasal headache the same as sinusitis? No. Contact point and nerve-related headaches can occur with clear sinuses on the CT scan.

Will surgery cure my migraine? Surgery treats a nasal source of pain; it does not cure migraine. It is considered only when tests point to the nose.

Is the surgery painful? It is done under anaesthesia. Discomfort afterwards is usually managed with simple painkillers and saline rinses.

References

• Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
• Harrison L, Jones NS. Intranasal contact points as a cause of facial pain or headache: a systematic review. Clinical Otolaryngology. 2013;38(1):8-22.
• Patel ZM, Kennedy DW, Setzen M, Poetker DM, DelGaudio JM. "Sinus headache": rhinogenic headache or migraine? An evidence-based guide to diagnosis and treatment. International Forum of Allergy & Rhinology. 2013;3(3):221-230.

Related reading: Can sinusitis cause headache every day? · Why does my nose block and head ache in AC? · Can sinus cause neck and shoulder pain?

About the author

Dr. Prashanth R. Reddy is a Senior Consultant ENT Surgeon in Bengaluru (MS ENT; Fellowship in Rhinoplasty, Seoul; MBA, IIM Bangalore) with over 20 years of practice. He sees patients at Sakra World Hospital, Marathahalli and at the ENTHealth360 clinic in Koramangala. His practice focuses on nasal causes of headache, snoring and sleep-disordered breathing.

For educational purposes only. Not a substitute for medical advice. Please consult a qualified ENT specialist.