The forehead, nose, and cheeks are innervated by the fifth cranial nerve, the trigeminal nerve. This nerve carries all sensory information of touch, pressure, heat or cold, or pain to the brain.

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.

Contact between the lateral nasal wall and the central nasal septum can provoke headache. The headache is located frontally or in the forehead or nose. Headache may be episodic or chronic. It is aggravated by allergic rhinitis, colds, and the flu.

The diagnosis may be made by ENT performing nasal endoscopy. Touching the involved area aggravates the pain and lidocaine injection improves the pain. Diagnosis is also made by viewing nasal contact between the nasal septum and the nasal wall on a brain MRI or sinus CAT scan.

Contact point headache is also termed “Sluder’s Neuralgia and anterior ethmoidal neuralgia and rhinogenic contact point headache.”

Related questions

What causes it?

Causation is thought to be physical touching of two opposing nasal mucosal surfaces.

Have randomized studies supported surgery for contact point headache?

No, randomized studies do not support surgery. Surgery may be considered in cases which have failed conventional headache treatment and ENT evaluation.

What medical treatments are helpful?

Conservative treatment is the use of nasal decongestants as oral pills or nasal sprays.

1 Behin F, Lipton RB, Bigal M. Migraine and intranasal contact point headache: is there any connection? Curr Pain Headache Rep 2006;10:312–315.PubMed

2 Behin F, Behin B, Behin D, Beredes S. Surgical management of contact point headaches. Headache 2005;45:204–210.PubMed

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Britt Talley Daniel MD