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ORIGINAL RESEARCH article

Front. Pain Res.
Sec. Headache
Volume 6 - 2025 | doi: 10.3389/fpain.2025.1521500

Anatomical and physiological contributions of nasal turbinate vessels and lymphatics to the pathogenesis of nasal congestion in recurrent headaches: A pilot study

Provisionally accepted
Jacob M. Chmielecki Jacob M. Chmielecki 1Vemula Aishwarya Vemula Aishwarya 1Joyce Schwartz Joyce Schwartz 2Jonathan A. Gelfond Jonathan A. Gelfond 1William Thomas Phillips William Thomas Phillips 1*
  • 1 The University of Texas Health Science Center at San Antonio, San Antonio, United States
  • 2 Methodist Hospital, San Antonio, Texas, United States

The final, formatted version of the article will be published soon.

    The aim of this study was to determine if specific anatomical changes were present in patients with recurrentchronic primary headaches including patients with chronic migraines, chronic tension-type headaches, and daily persistent headaches. The A retrospective study of 200 patients was performed to evaluate the potential of measuring the amount of nasal blood pool activity (nasal congestion) as a predictive marker for chronicrecurrent headaches. including migraines, tension headaches, and unspecified headaches.Methods: A cohort analysis was performed involving patients who had been referred to the Nuclear Medicine Clinic over a 3-year period for whole-body blood pool scans. The scans were evaluated by region of interest (ROI) analysis of nasal and heart max pixel count ratios (NHMRs) to determine an association between nasal blood pooling activity and chronicrecurrent headaches at the time of the initial scan and in follow-up evaluations over a period of 3-6 years.Results: Significantly greater NHMRs were observed in 122 patients with chronic headaches at the time of referral for their initial whole-body blood pool scan when compared with those patients without chronicrecurrent headaches (p = 0.004; OR 10.5; 95% CI 2.22-56.7). An additional 15 patients, for a total of 137, developed chronicrecurrent headaches following their initial scan and before their follow-up evaluation. NHMRs were also significantly increased in the additional patients when compared to those without chronicrecurrent headaches (p = 0 .004; OR 12.3; 95% CI 2.34-75.5).Patients with chronicrecurrent headaches have significantly increased nasal activity as observed on 99m Tc-MDP whole-body blood pool scans, supporting the hypothesis that nasal lymphatic dysfunction plays a role in the etiology of chronicrecurrent headaches. This research highlights a novel diagnostic use of the whole-body blood pool scan for the assessment of nasal turbinate vasodilation as well as a possible new target for the treatment of chronicrecurrent headaches..

    Keywords: glymphatics, Headaches, Migraines, Nasal turbinate, Topiramate, whole-body blood pool scintigraphy

    Received: 01 Nov 2024; Accepted: 23 Jan 2025.

    Copyright: © 2025 Chmielecki, Aishwarya, Schwartz, Gelfond and Phillips. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: William Thomas Phillips, The University of Texas Health Science Center at San Antonio, San Antonio, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.