HEADACHES FROM NASAL CAUSES. 
BY 
SARGENT F. SNOW, M.D., 
OF SYRACUSE, N. Y.J 
AURIST AND LARYNGOLOGIST TO THE HOUSE OF THE GOOD SHEPHERD, 
SHELTER FOR HOMELESS WOMEN, AND TO THE 
SYRACUSE FREE DISPENSARY. 
FROM 
THE MEDICAL NEWS, 
July IO, 1897. [Reprinted from The Medical News, July 10, 1897.] 
HEADACHES FROM NASAL CAUSES.1 
By SARGENT F. SNOW, M.D., 
OF SYRACUSE, N. Y. ; 
AURIST AND LARYNGOLOGIST TO THE HOUSE OF THE GOOD 
SHEPHERD, SHELTER FOR HOMELESS WOMEN, AND TO 
THE SYRACUSE FREE DISPENSARY. 
In this paper I do not intend to dwell to any ex- 
tent on the history of individual cases but to give a 
sort of abstract of experience, selecting as a basis for 
conclusions only representative cases which have been 
followed up carefully, a table of which is appended. 
Neither will I include those headaches associated 
with inflammatory disease of the accessory cavities, 
this latter affection having been so comprehensively 
written up during the past three years. 
In a paper on " Hemicrania " 2 I have called at- 
tention to pressures within the noseas a cause of sick 
headaches and neuralgic affections. At that time it 
was felt that perhaps an apology was due for ventur- 
ing on a subject so nearly barren of literature. Now 
I am pleased to find that others both here and abroad 
are giving the nasal passages due credit. As early as 
1886 Dr. Harrison Allen of Philadelphia published 
a paper on " Headaches Associated Clinically with 
Chronic Nasal Catarrh."3 The essay was compre- 
hensive, replete with valuable deductions, and with- 
out doubt was the first published on the relation of 
headaches to intranasal conditions. In a foot-note 
1 Read before the American Laryngological, Rhinological, and 
Otological Society, Washington, D.C., May i, 1897. 
2 New York Medical Journal, March 31, 1894. 
3 The Medical News, March 13, 1886. 2 
he mentions a discussion touching on this subject 
which took place at the New York Academy of Med- 
icine, January 21, 1886, but after his paper was writ- 
ten. In 1888 Dr. JohnO. Roe contributed a paper, 
entitled " The Frequent Dependence of Persistent 
and So-called Congestive Headaches upon Abnormal 
Conditions of the Nasal Passages." 1 Aside from 
these, and the mention made of the nose as a factor 
by Dr. Wharton Sinkler in an excellent article on 
the " Etiology and Treatment of Migrain " 2 I have 
been unable to find record of any paper relating to 
this subject by American writers until that produced 
by myself in 1893. 
From all data at command, I think Dr. Hack 
of Freiburg (quoted by Sinkler) was the pioneer in 
Europe in recognizing the fact that headaches some- 
times come from nasal causes. Maximilian Bresgen 
of Frankfurt wrote a paper on " The Headaches in 
Nose and Throat Diseases," 3 a copy of which he has 
courteously sent me. This article is very clear and 
concise, pointing out with detail the regions which 
most commonly produce headaches, and their great 
frequency as a symptom in nose and throat diseases. 
At a meeting of the British Laryngological Associa- 
tion, held in London, October 12, 1894, Mayo Col- 
lier reported a case of '' Headache from a Diseased 
Middle Turbinal. " Dr. J. H. McCassy of Dayton, 
Ohio,4 in connection with his experience as superin- 
tendent of the Kansas State Insane Asylum, says: 
" As might be expected, headache is alarmingly 
1 Medical Record, August 25, 1888. 
2 The Medical News, July 19, 1890. 
3 Munch. Med. Woch., January 5, 189}. 
4 Cincinnati Lancet-Clinic, Septembers, 1896. 3 
common among the insane. I am convinced that 
hypertrophies, vasomotor rhinitis, polypoids, de- 
flections of the septum, catarrh of the ethmoidal, 
frontal, and maxillary sinuses, etc., are frequently 
causes of headaches, and in not a few cases of in- 
sanity. ' ' 
For a number of years past the neurologist and the 
ophthalmologist have had full sway in the treatment 
of these cases. They have published many valuable 
books and papers and should receive due credit. 
One of the recent productions is Corning's on 
" Headaches and Neuralgia. ' ' The author does not 
even speak of a possible nasal cause in his classifica- 
tions, though he mentions at considerable length 
those termed nervous, toxic, bilious, etc. Errors of 
refraction must, of course, be corrected, but the 
rhinologist should have a place in this line of work. 
I have selected from my records thirty cases of ceph- 
alalgia that have been referred to me as a last resort 
by different physicians. These patients on examina- 
tion appeared to be fit subjects to work upon and 
treatment was instituted. They do not include 
those met with in any hospital or dispensary prac- 
tice, or those who have been mentioned inciden- 
tally during the course of ear or throat treatment, 
where nasal surgery has been a prominent feature, 
and by means of which their headaches had been 
cured. In this group of thirty patients I find 
that seven claim to have received relief to the 
extent of about 40 per cent., five 75 per cent., 
ten 90 per cent., and eight 100 per cent. A 
careful review and study of their records bring out 
some interesting points. Sixteen were treated be- 4 
tween 1891 and 1894, giving from three to five 
years in which to judge of results. Ten of these 
show from 90 to 100 per cent, relief of their head- 
aches. Twenty of the thirty cases were females. 
The youngest was seventeen and the oldest sixty-five 
years of age. Sixty per cent, of the whole number 
were from thirty to forty years of age. Seventy per 
cent, of these patients appeared to have hemicrania 
as a result of middle turbinate pressure. Of those 
reported as showing 100 per cent, relief, the whole 
number, eight, received a full and thorough operative 
course. Fourteen, because of their improved condi- 
tion, stopped treatment before all the visible intra- 
nasal contacts and pressures were removed. The 
remaining eight had a complete operative course, 
but owing to the sensitive condition of their mem- 
branes they are yet having some headaches, though 
four are found in the 90-per-cent. class. Another 
notable fact deduced from these thirty cases is that 
of the sixteen who received a full operative course, 
twelve report from 90 to 100 per cent, improve- 
ment. Experience with other cases not mentioned 
in this list teaches me that about the same ratio of 
improvement (75 per cent.) will hold good in all 
headaches from nasal causes, if each and every point 
of pressure or contact is thoroughly removed. Oper- 
ative work on these patients is what gives quickest 
and most brilliant results. It should be carried out 
with the fact in mind that the nasal membranes are 
very sensitive and prone to swell, and a little more 
of the offending overgrowth than is necessary to abso- 
lutely relieve the pressure should be removed, though 5 
not enough to impair the natural function of the 
nose. 
Hajek of Vienna attributes the headaches so com- 
monly met with after tamponing the nose and in 
acute coryza to a stasis. His opinion is that the 
veins passing through the lamina cribrosa give off 
one large branch to the dura mater, turn, and again 
enter the nasal cavities; these become engorged, 
press against the brain substance, and occasion severe 
pain. Schreck of Munich looks upon hemicrania, 
due to nasal and postnasal causes, as partly attrib- 
utable to the hindered flow of lymph and venous 
blood from the brain. Dr. Robert C. Myles of New 
York writes me that in his opinion " vasomotor dis- 
turbances of this region or compression of the small 
nerves in the bony canals of the cribriform plate by 
the artery or vein will cause headaches under certain 
conditions." This theory of stasis produced by a 
retarded circulation, coming as it does from three 
eminent and independent sources, should receive 
consideration. Perhaps it will explain why some 
twenty-five per cent, of our patients have an oc- 
casional return of their trouble after all visible pres- 
sures and contacts have been removed. According 
to some neurologists, it may be due to the fact that 
" all influences exerted upon the human body are to 
a greater or lesser degree cumulative, and the phe- 
nomena following these are proportionate to the re- 
sponse yielded by the receiving nerve-centers." 
Personally, I think that most of these recurring at- 
tacks are produced by the irritable and sensitive 
condition of the membranes, which favor congestion 
with resulting pressure on sensitive areas. 6 
In those cases of headaches from nasal causes which 
have come under my observation, but two can be 
recalled in which the patients at the time of their 
seizures did not show some point or points of contact 
within the nasal fossae. Their relapses may be due 
to stasis as mentioned above. It has been noticed 
that they as well as others are kept very comfortable 
if weekly or biweekly stimulating applications be 
made in order to keep the relaxed and sensitive 
membranes in proper tone. The treatment that ap- 
pears to act best in producing this result is a gentle 
spraying of the parts with iodole and ether, the pa- 
tient being instructed to breathe through the nostrils 
quickly if the application produces too much smart- 
ing pain. Three grains to the ounce of this mixture 
is a good strength for these tonic treatments, and 
the same combination, preceded if necessary by 
a two-per-cent, cocain spray to allay smarting, 
is very efficacious in reducing acute or subacute 
nasal and postnasal inflammation. In fact, it is 
good in temporary turgescence from any and all 
causes. 
Without doubt some cases of migrain are of the 
nature of 11 nerve storms " and are closely allied to 
epilepsy, but it appears very probable that these 
nerve storms are primarily brought about by some 
irritation of a nerve filament, such as is produced by 
contact of the inner surface of the middle turbinate 
body with the septum. 
My paper on "Hemicrania," written in 1893, 
contained the proposition that there are a certain 
number of headaches which can be cured, or at least 
relieved, by the proper treatment of pressures or 7 
■contacts within the nose. Added experience during 
the past four years, together with the observations of 
other workers, has amplified this idea until it surely 
appears that we are safe in advising those who come 
to us with a history of persistent or recurring neural- 
gia, clavus, sick headache, pressure on top of the 
head, or the deep frontal pain commonly termed 
catarrhal headache, to have their nasal and post- 
nasal passages put in the best possible condition. I 
am about ready to believe that from 70 to 80 per 
cent, of all cases of headaches of hemicranial order 
are due to removable causes located within the nasal 
passages or adjacent air spaces. 
As intimated above, the treatment par excellence 
for these obstinate cases in which we find evidence 
of nasal disease of whatever nature is the correction 
of that disease by the means indicated. If we have 
reason to think that the trouble comes from the ac- 
cessory sinuses these must be drained. If the space 
between the septum and a middle turbinated body is 
too narrow, or if this same body is overgrown anteri- 
orly or presses against the outer wall of the nose, pre- 
venting free access of air into or drainage of the sinuses, 
it must be reduced in some manner. If bony shelves, 
membranous or cartilaginous thickenings causing 
pressure are found, these should be taken care of. In 
some cases one fails to find any of these deformities, 
and perhaps at the time of examination there are no 
points of contact, but it will be noticed that the 
membranes are of a peculiar bluish-red color, and 
have a sensitive or relaxed appearance which is an indi- 
cation that within the next half hour there may be 
some localized spot of pressure. This condition 8 
does not require operative interference, but will 
usually respond to persistent and stimulating treat- 
ment, together with proper regulation of the habits, 
manner of living, exercise, etc., and, according to 
Roe, if the patient resides in the Lake region, avoid- 
ing too great a quantity of night air in the sleeping 
apartment. 
One word further, regarding those patients suffer- 
ing from an attack of headache, who ask for tem- 
porary relief. Inspection of their nasal passages will 
perhaps show marked pressures in the olfactory 
region, which may be due to an acute or subacute 
inflammation without much chronic disease, and 
without osseous deformity or overgrowth. About 
ninety per cent, of these patients can be relieved in 
one or a few treatments by cleansing the nostrils, 
and using the iodole and ether mixture, preceded by 
a light two per cent, cocain spray, as described 
above. Sometimes this will have to be repeated in 
four or five hours, but one treatment usually breaks 
up ah attack. Cases number 22 and 27 in the ap- 
pended table well represent this class. 
The desire to be brief has hindered me from quot- 
ing other authors, who have written on headaches, 
and forced me to leave out many things that I 
would have liked to mention; still I hope that proof 
enough has been brought forward to cause the 
rhinologist to take a more active interest in reflex 
headaches. 9 
No. 
Name. 
Began 
treatment. 
Relieved. 
Intranasal 
conditions. 
Remarks. 
Mrs. K. 
32 
April 16, 1892 
Per 
cent. 
40 
Deep bony 
Severe sick 
2. 
Miss J. 
32 
Aug. 18, 1892 
40 
shelf pressing 
into r. mid. 
turb. 
Enlarged 
headache each 
week. 
Bimon t h 1 y 
3- 
Mrs. F. 
45 
Nov. 5, 1892 
75 
mid. turb. 
Enlarged 
sick headache. 
Bimon t h 1 y 
4- 
Mrs. L. 
35 
Dec. 3, 1892 
40 
mid. turb. 
Septal shelf 
hemicrania. 
Severe hemi- 
5- 
Miss H. 
25 
Oct. 7, 1892 
TOO 
pressing i n f. 
turb. 
Septal shelf 
crania at times 
each week. 
Frequent 
6. 
Mr. K. 
56 
April 14, 1892 
IOO 
pressing i n f. 
turb. 
Enlarged 
hemicrania. 
Severe 
7- 
Mrs. Y. 
55 
Feb. 23, 1802 
IOO 
mid. turb. with 
thickened 
membranes. 
Septal shelf 
hemicrania tri- 
monthly. 
Clavus and 
8. 
Dr. S. 
30 
Mar. 23, 1892 
90 
and deflected 
septum. 
Deflected sep- 
general head- 
aches. 
Hemicrania 
9- 
Miss G. 
32 
May 9, 1892 
90 
turn pressing r. 
mid. turb. 
Deflected sep- 
once a week. 
Severe hemi- 
IO. 
Miss F. 
25 
Nov. 17, 1892 
75 
turn, large 
shelf, and mid. 
turb. 
Deflected sep- 
crania. Died 
of general tu- 
berculosis i n 
1895. 
Severe hemi- 
IT . 
Mrs. C. 
35 
Jan. 17, 1893 
75 
turn, large 
shelf, etc. 
E n larged 
crania, when 
she has colds. 
Severe 
12. 
Mrs. R. 
50 
Oct. 26, 1893 
9° 
mid. turb. 
Atrophic 
weekly hemi- 
crania, pres- 
sure on top of 
head. 
Pers i s t e n t 
rhinitis, e n - 
larged turb. 
general head- 
aches almost 
constant. 10 
No. 
Name. 
Age. 
Began 
treatment. 
Relieved. 
Intranasal 
conditions. 
Remarks. 
Per 
cent. 
13- 
Miss C. 
17 
June 24, 1893 
90 
Enlarged 
mid. turb. 
Headach es 
and pressure 
top of head bi- 
monthly. 
14- 
Mr. C. 
38 
May 18, 1893 
100 
Septal shelf 
and thickened 
mid. turb. 
General 
headaches. 
i5- 
Miss B. 
'9 
Mar. 23, 1893 
100 
Septal shelf 
and swollen 
mid. turb. 
Severe sick 
headache b i- 
monthly. 
16. 
Mr. M. 
36 
April 20, 1893 
100 
Septal shelf 
and swollen 
mid. turb. 
Severe sick 
headaches bi- 
monthly. 
17- 
Mr. S. 
38 
May 21, 1894 
40 
Long shelf 
pressing into 
mid. turb., etc. 
Severe hemi- 
crania once a 
week. 
18. 
Miss R. 
26 
June 27, 1894 
75 
Deflecte d 
septum, mid. 
turb., filling in- 
fundibula, r. s. 
Hemicrania 
bimonthly. 
19. 
Prof. K. 
36 
Jan. 17, 1894 
75 
Thick mem- 
brane and en- 
larged turb. 
Severe and 
frequent hemi- 
crania. 
20. 
Dr. L. 
27 
Dec. 29, 1894 
90 
Cartilagenous 
thickening, 
pressing mid. 
turb., 1. s. 
Deflected sep- 
tum pressing 
1. mid. turb. 
S e v e re 
frontal head- 
aches, tri- 
monthly. 
21 . 
Miss S. 
65 
April 18, 1894 
9° 
General 
headaches. 
22. 
Mrs. B. 
33 
May 11, 1894 
9° 
Thic k e n e d 
membrane on 
mid. turb. and 
septum. 
F requent 
headaches. 
23- 
Miss W. 
33 
Nov. 2, 1894 
90 
Mid. turb. 
pressure 0 n 
septum. 
Neuralgia 
and severe 
headache. 11 
No. 
Name. 
•a3v 
Began 
treatment. 
Relieved. 
Intranasal 
conditions. 
Remarks. 
24. 
Mrs. H. 
32 
Jan. 
7, 
1894 
Per 
cent. 
100 
Mid. turb. 
Very fre- 
25. 
Mr. C. 
35 
June 
4, 
1895 
9° 
pressure on 
septum, filling 
infundibula. 
Thickenings 
quent, severe 
sick head- 
aches. 
Severe neu- 
26. 
Mr. N. 
28 
Feb. 
6, 
1896 
40 
and enlarged 
mid. turb. 
Septal shelf, 
ralgia, and 
hemicrania. 
Cata r r h a 1 
27. 
Mrs. L. 
40 
Oct. 
1896 
40 
and thickened 
membranes. 
Swollen and 
headaches. 
Severe hemi- 
28. 
Dr. B. 
40 
Oct. 
IO, 
i8q6 
IOO 
sensitive mem- 
branes over 
mid. turb. 
Septal shelf, 
crania, when 
she has cold. 
F requent 
29. 
Mrs. T. 
37 
Nov. 
5, 
1896 
90 
and sensitive 
membranes. 
Enlarged 
general head- 
aches. 
Very severe, 
3°- 
Mr. S. 
45 
Oct. 
2, 
1896 
40 
mid. turb. 
Enlarge d 
sick h e a d - 
aches twice a 
week. 
Hemicrania 
mid. turb., and 
polypoid mem- 
branes. 
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