What is a contact point headache (Sluder's neuralgia)?

Short answer: A contact point headache (Sluder's neuralgia) is pain that starts where two surfaces inside the nose press against each other, for example a bent septum or a bony spur touching a turbinate. The pressure can irritate nerve endings and refer pain to the forehead, eye or temple. It is diagnosed with nasal endoscopy, a CT scan and sometimes a numbing test.

Key takeaways

• Doctors also call it rhinogenic contact point headache or mucosal contact point headache.
• The pain usually sits on one side, around the eye, forehead, temple or cheek.
• It is often mistaken for migraine or "sinus headache", so the nose may never be examined.
• Diagnosis needs an ENT examination: nasal endoscopy, a CT scan and, in some cases, a numbing test.
• Treatment is first medical; surgery is considered only in carefully selected patients.

Dr. Prashanth's perspective

Contact point headaches (Sluder's neuralgia) are usually diagnosed with a nasal endoscopy or a CT scan of the nose. I find the CT scan especially useful, because it also shows the condition of the sinuses, which an endoscopic examination alone cannot fully assess.

— Dr. Prashanth R. Reddy, ENT Surgeon, ENTHealth360

What happens inside the nose?

The inside of the nose is lined with a sensitive mucous membrane supplied by branches of the trigeminal nerve, the main nerve of sensation for the face and head.

Normally there is a small air gap between the septum (the central wall) and the turbinates (the bony shelves on the side walls). When a deviated septum, a septal spur, an air-filled middle turbinate (concha bullosa) or a large turbinate closes that gap, the two surfaces touch. If the lining swells with a cold, allergy, dust or air-conditioning, the pressure at that point rises.

This constant contact is thought to irritate the nerve endings and release pain-signalling substances. The brain then feels the pain as headache in the area served by the same nerve, often behind or around the eye.

What does it feel like?

There is no single pattern, but many patients describe:

• Pain on one side, around or behind the eye, the forehead, the temple or the cheek.
• A dull, pressing or boring ache that can build into a severe headache.
• Headaches that worsen with a cold, allergy, weather change or air-conditioning.
• A blocked nose on the same side as the pain.
• Little relief from regular painkillers or migraine medicines.

Because these features overlap with migraine, tension headache and sinusitis, a headache diary is useful. Note the side, the time, triggers and any nasal symptoms.

How is it diagnosed?

A contact point headache is a diagnosis an ENT makes after examining the inside of the nose and ruling out other causes.

• Nasal endoscopy: a thin camera shows the septum and turbinates and whether they touch.
• CT scan of the nose and sinuses: shows the contact point clearly and also the condition of the sinuses.
• Local anaesthetic (numbing) test: a small amount of anaesthetic is placed on the contact point. If the headache eases soon after, it supports the nose as the source.
• Ruling out other causes: migraine, cluster headache, sinus infection, dental problems and other neurological causes are considered. A neurologist's opinion is sometimes needed.

The International Headache Society lists headache attributed to disorders of the nasal mucosa, turbinates or septum in its classification (ICHD-3), and asks that the headache match the side and timing of the nasal finding and improve when the contact is treated or numbed.

Contact point headache, Sluder's neuralgia and migraine

The term Sluder's neuralgia comes from Greenfield Sluder, who in the early 1900s described one-sided facial and eye pain linked to the nose and the sphenopalatine ganglion, a nerve junction behind the nose. Many ENT papers today use it alongside rhinogenic contact point headache.

A contact point can also act as a trigger in people who already have migraine. This is why an ENT and a neurologist sometimes work together, and why not every headache with a deviated septum comes from the nose. Contact points are common on CT scans in people with no headache at all, so the scan must be read together with the symptoms.

How nose breathing connects to energy and BMR

Your basal metabolic rate (BMR) is the energy your body burns at rest to keep the heart beating, the brain working and cells repairing. Your cells make that energy using oxygen, so how well you breathe matters.

• Warm, moist, filtered air. The nose warms, humidifies and filters each breath before it reaches the lungs. Mouth breathing skips this step.
• Nitric oxide from the sinuses. The sinuses continuously make nitric oxide (NO), a natural gas. Breathing in through the nose carries small amounts to the lungs, where studies suggest it may help oxygen uptake.

The same contact points that trigger headache often narrow the airway on that side, which can push you towards mouth breathing at night and disturb sleep. Nose breathing does not "boost" your BMR, but comfortable nasal breathing and undisturbed sleep support the energy your body uses to work and recover.

How is it treated?

Treatment depends on how often the headaches come and how much they affect daily life.

Medical treatment first. Saline rinses, a steroid nasal spray, allergy control and avoiding triggers such as dust and direct air-conditioning reduce swelling of the lining and often reduce the pressure at the contact point. Overuse of painkillers is reviewed, as it can itself cause daily headache.

Surgery in selected patients. When the headache is frequent, the contact is clear on endoscopy and CT, other causes have been excluded, and a numbing test supports the nose as the source, endoscopic surgery to remove the contact may be considered. Depending on the anatomy this may be a septoplasty, removal of a spur, reduction of a turbinate or correction of a concha bullosa. It is done through the nostrils with an endoscope, with no cut on the face. Published long-term studies report lasting improvement in many carefully selected patients, but results vary and surgery is not suitable for every headache.

When should you see an ENT?

• Headache mostly on one side that keeps coming back, with a blocked nose on the same side.
• Headache that worsens with colds, allergy or air-conditioning.
• Headache with little relief from painkillers or migraine medicines.
• Headaches labelled "sinus" that never seem to settle.
• Seek urgent care for a sudden, severe "worst-ever" headache, headache with fever and a stiff neck, weakness, confusion, vision loss or swelling around the eye.

Frequently asked questions

Is a contact point headache the same as a sinus infection? No. A sinus infection usually comes with thick discharge, fever or reduced smell. A contact point headache can occur with clear sinuses; the problem is two surfaces touching.

Will a CT scan alone confirm it? No. Contact points are common in people without headache. The scan is read together with the symptoms, the endoscopy and, if needed, a numbing test.

Does everyone with a deviated septum get headaches? No. Many people with a bent septum have no headache at all. It matters only when the deviation presses on the side wall and matches the pain.

Can it be treated without surgery? Often, yes. Nasal sprays, saline and trigger control help many people. Surgery is considered only when symptoms persist and the tests point clearly to the nose.

References

• Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
• Welge-Luessen A, Hauser R, Schmid N, Kappos L, Probst R. Endonasal surgery for contact point headaches: a 10-year longitudinal study. Laryngoscope. 2003;113(12):2151-2156.
• Behin F, Behin B, Bigal ME, Lipton RB. Surgical treatment of patients with refractory migraine headaches and intranasal contact points. Cephalalgia. 2005;25(6):439-443.
• Maniaci A, Lechien JR, Calvo-Henriquez C, et al. Long-term stability of outcomes of endoscopic surgery for rhinogenic contact point headache (Sluder's neuralgia). American Journal of Otolaryngology. 2022;43(3):103368.
• Lavalle S, Pace A, Magliulo G, et al. Impact of nasal anatomical variation subtype on surgical outcomes for rhinogenic contact point headache. Diagnostics. 2025;15(2):121.
• Lundberg JO, Farkas-Szallasi T, Weitzberg E, et al. High nitric oxide production in human paranasal sinuses. Nature Medicine. 1995;1(4):370-373.

About the author

Dr. Prashanth R Reddy is an ENT surgeon at ENTHealth360, Bangalore (MS ENT; MBA, IIM Bangalore; Seoul Rhinoplasty Fellowship), seeing patients at Sakra World Hospital, Marathahalli and in Koramangala. His practice focuses on how breathing affects sleep, energy and everyday performance, including nasal causes of headache.

Related reading: Why do I get nose blocks and headaches in AC? · Why does my sinus keep coming back every few months?

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