ROLE OF AN INTERNAL NASAL DEVICE (BEST BREATHE) IN HEADACHE PATIENTS

• DOI: https://doi.org/10.22533/at.ed.159410424131213

• Palavras-chave: Primary headaches, secondary headaches, tension-type headache

• Keywords: Primary headaches, secondary headaches, tension-type headache

• Abstract:

  Importance: Many headaches are diagnosed as primary (migraine and tension headaches), whose treatment is palliative. They could be related to sleep disordered breathing and chronic intermittent hypoxia. If this is so, some primary headaches should be included in the group of secondary headaches.
  Objective: To analyze the influence of nocturnal internal nasal dilator on oxygen saturation levels in patients with and without headaches. 
  To investigate the possible relationship between primary headaches and sleep disordered breathing. We performed a 3D study of the airways by cone beam computed tomography (CBCT) and evaluated oxygen saturation levels before and after the use of the nocturnal internal nasal dilator. 
  Design, location and participants: 
  Observational case-control study carried out from September 2017 to September 2018 in a dental clinic specialized in prosthetic rehabilitation in Murcia (Spain). From the initial number of patients (400), 200 (n=200) were selected. They were fitted with an internal nasal dilator, measuring oxygen saturation before placement, one week and one month after placement. The patients were classified into two groups, CP primary headaches (n= 108) and GC control group (n= 92) who were first visits who came to the clinic for study due to problems of missing teeth and temporomandibular joint (TMJ) dysfunction and did not have headaches.
  Interventions 
  All were given a subjective functional and sleep test (Epworth test). We performed a muscle examination (cranio-cervical and craniomandibular palpation), temporomandibular joint (TMJ) and dental examination, and a 3D scan using cone-bean computed tomography (CBCT) to explore the patency of the airways. 
  Results and main measurements: In the descriptive study of clinical variables of the patients with headaches, tension headaches were observed in 64 (59%). Both in the functional or subjective tests and in the muscular exploration there was a statistically significant association between the group of patients with headache and the presence of symptoms (muscular, articular, dental, poor sleep and mouth breathing) so that the percentage of patients with symptoms was significantly higher than in the control group.  On examination by cone-bean computer tomography (CBCT), variables such as the presence of turbinate hypertrophy, septal deviation and the decrease in the oro-pharyngeal space showed significant differences between the two groups, being higher in patients with headaches. After placement of the nasal dilator, a significant increase in saturation was observed in patients with headache at one week and one month after its use, and the patients improved their headache.
  Conclusions and development: By improving oxygen saturation and improving inspiratory flow limitation with the use of the internal nasal dilator some headaches improve, reducing the dose and time of palliative pain medication. Therefore, they would not be primary headaches or of unknown origin but secondary ones.