• Rhinologic cephalgia;
  • four-finger headache;
  • nasal pain


Objective To introduce a minimally invasive method to eliminate the symptoms of contact-point rhinologic cephalgia.

Study Design A prospective study of 55 patients with chronic nasal or glabellar pain and endoscopically proven nasal origin.

Methods All 55 patients in whom endoscopic examination demonstrated a contact point between the middle turbinate and the nasal septum were treated by fracturing the middle turbinate lateralward using a small metal tongue depressor under 10% lidocaine HCL topical anesthesia.

Results Of the treated cohort, 48 (87%) of the patients had complete clinical symptom resolution after one treatment and all had resolution after two treatments. Recurrence occurred in 1 patient. There were no short-term or long-term adverse sequelae. The results persisted at a mean follow-up time of 50 months (range, 6–84 mo).

Conclusion Middle turbinate lateralization is safe and effective in eliminating the symptoms of rhinologic cephalgia induced by contact point between the middle turbinate and nasal septum.