The Frequent Dependence of 
Persistent and so-called Con- 
gestive Headaches upon Ab- 
normal Conditions of the 
Nasal Passages. 
JOHN O. ROE, M. D. 
BY 
ROCHESTER. N. Y. 
FELLOW OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION ; MEMBER OF THE 
BRITISH MEDICAL ASSOCIATION, OF THE MEDICAL SOCIETY OF THE STATE 
OF NEW YORK, OF THE AMERICAN MEDICAL ASSOCIATION, OF THE 
CENTRAL NEW YORK MEDICAL ASSOCIATION, OF THE 
MONROE -ETG.r —— : 
« * rw’f r 
Reprinted from The Medical "Record, August 25, i&B#. 
NEW YORK 
TROW’S PRINTING AND BOOKBINDING CO., 
201-213 East Twelfth Street. 
1888. The Frequent Dependence of 
Persistent and so-called Con- 
gestive Headaches upon Ab- 
normal Conditions of the 
Nasal Passages. 
BY 
JOHN O. ROE, M. D. 
ROCHESTER. N. Y. 
FELLOW OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION ; MEMBER OF THE 
BRITISH MEDICAL ASSOCIATION, OF THE MEDICAL SOCIETY OF THE STATE 
OF NEW YORK, OF THE AMERICAN MEDICAL ASSOCIATION, OF THE 
CENTRAL NEW YORK MEDICAL ASSOCIATION, OF THE 
MONROE COUNTY MEDICAL SOCIETY, ETC., ETC. 
Reprinted from The Medical Record, August 25, 1888. 
TROW’S PRINTING AND._IUTO-K-RRN-DIN G• 'CGr 
NEW YORK 
201-213 East Twelfth Mt'. 
188&. THE FREQUENT DEPENDENCE OF PERSIST- 
ENT AND SO-CALLED CONGESTIVE HEAD- 
ACHES UPON ABNORMAL CONDITIONS OF 
THE NASAL PASSAGES.1 
There is perhaps no single affection that causes so large 
an amount of human suffering, and which is regarded so 
lightly, as that known by the generic term, headache. 
There is also no affection that has so many different 
types, nor one which is caused by such great variety of 
bodily conditions. It not only attends nervous affections, 
but is a frequent complication of nearly every other form 
of disease. 
A headache is, in every instance, a warning of some dis- 
ease or derangement that should be sought out and cor 
reeled. Dr. Day very truly says: “The subject of 
headache is of manifest importance, because it claims so 
many sufferers and is surrounded by so many difficulties; 
the pathology is obscure, the diagnosis perplexing, the 
remedies uncertain. Headache is a disorder of the most 
frequency, and yet there is none which more taxes the 
experience and scientific knowledge of the physician, or 
requires closer observation in elucidating its nature and 
removing its obscurity.”8 
The connection between abnormal conditions of the 
nasal passages and certain forms of headache was recog- 
1 Read before the Medical Society of the State of New York, February 
9th, 1888. 
2 Headaches: Their Nature, Causes, and Treatment. Am. Ed., 
1883, p. 11. 4 
nized a long time before we had any definite knowledge 
concerning diseases of the nose. These headaches were, 
however, only those observed to be associated with, or 
caused by, an engorged condition of the nasal passages, 
usually that attending a cold in the head, and were there 
fore termed “ catarrhal headaches.” 
Headaches caused by chronic abnormal conditions of 
the nasal passages, in which the nasal derangement played 
a less conspicuous part, were sometimes attributed to 
other causes, and the nasal disease was entirely overlooked 
or unsuspected. In case of entire failure to detect u 
cause, the headache is often termed “nervous” or “con- 
gestive,” or by that most comforting of terms, “ idio- 
pathic.” 
The physical relations of the nose to the other portions 
of the human system are very important; for in diseases 
of this organ not only are the well-known offices which it 
performs interfered with, but derangements are produced 
in other organs and parts. Such derangements may be 
the effect not simply of cutting off nasal respiration, but 
of the irritation that is reflected from the nose to other 
parts through its abundant nervous connections. 
An impetus was given to the study of nasal neuroses 
when it was shown that nearly all the phenomena attend- 
ing hay-fever were reflected irritations from the nose ; and 
also that many other neuroses, such as megrim, facial 
spasm, choreic symptoms, epileptiform seizure, sneezing 
cough, laryngeal spasm and asthma, were frequently ex- 
cited by disease in the nasal chambers. 
With this array of symptomatic effects of nasal irrita- 
tion, together with the proximity of the nasal chambers, 
and their communicating cavities to the brain, we would 
naturally expect to find morbid impulses quite as often 
reflected to the head as to any other region. 
For the purpose of illustrating the clinical character of 
headaches of nasal origin, I have selected from the many 
instances that have come to my observation the following 
cases: 5 
Mr. A. K , fifty years of age, had been subject to 
persistent headaches for fourteen years. At first, the 
headache was slight. He would awaken with a headache 
in the morning, which would pass away during the early 
part of the forenoon, after exercising in the open air. 
This symptom steadily increased in severity and would 
continue longer during the day, until for two years pre- 
vious to the time I first saw him, his headache was per- 
sistent and continuous during the entire twenty-four hours. 
The pain was confined to the upper portion of the frontal 
region. There was no pain over the region of the frontal 
sinuses. The pain was a dull ache, like a sensation of 
pressure, with a feeling of fullness throughout the head. 
When I saw him, the pain had become so severe as to be 
almost unbearable. His ideas were confused and his 
memory had begun to fail him, so that he was apprehen- 
sive of softening of the brain, or some other severe disease 
in his head. A short time before his headache com- 
menced he began to be troubled with what he termed 
a “catarrhal ” difficulty, with more or less stoppage of the 
nostrils—particularly the left one —and also with con- 
siderable discharge. On lying down his nostrils became 
stopped and he was obliged to breathe through his mouth 
during sleep. His throat would become parched and 
dry, and there would be left a bad taste in his mouth in 
the morning. His headaches were considered to be a 
form of congestive headache, due to what is commonly 
termed “biliousness.” He was treated by a variety of 
physicians regulars, irregulars, and defectives—with 
no permanent benefit. A great deal of quinine was 
given him by those supposing it to be of malarial origin. 
The only medicines that seemed to give him any relief 
whatever were active cathartics, which seemed to con- 
firm the congestive and bilious theory. Accordingly, for 
the two years previous to the time I saw him he took a 
cathartic every day, such as pills of some sort, salts, 
senna, castor oil, rhubarb, cream of tartar, etc. A Turk- 6 
ish bath would also give him complete relief during the 
time that he was in the bath. 
On examination of the nasal passages I found a bony 
ridge projecting from the left side of the septum and 
pressing firmly into the left middle turbinated body. 
There was also some hypertrophy of both the inferior and 
middle turbinated bodies on that side. On the right side 
there was some general thickening of the mucous mem- 
brane, but the nostril was comparatively free. 
The bony ridge I removed with a nasal saw, and ap- 
plied the galvanic cautery to the turbinated hypertrophy. 
The result was complete and almost immediate relief 
from the headaches. For some time his whole scalp had 
been so sensitive that he could not endure the slightest 
pressure, but this sensitiveness of the scalp disappeared 
almost entirely with the headache. He is, however, still 
sensitive to draughts of cold air, but by keeping his head 
warm with a skull-cap or other closely fitting cap, he is 
exempt from every vestige of headache. Since he ceased 
treatment two years ago, he has taken no medicine what- 
ever, has enjoyed perfect health, and now says he feels 
better than he has felt at any time in fifteen years. 
Mr. E. R , aged twenty-seven, cigar-maker by trade. 
For a year and a half he had experienced an obstruction 
in the nose, which seemed to follow a severe cold in the 
head. This was followed by more or less ringing in the 
ears, profuse discharge from the nose, and soon after by 
a severe headache or pain confined to the occipital region 
on the left side. He also had more or less intermittent pain 
in the left side of the chest. This condition continued, 
and the pain grew steadily worse until he had to give up 
all work and became seriously alarmed as to his condi- 
tion. He was subject to frequent colds in the head, his 
nostrils were most of the time stopped, and he was obliged 
to breathe through his mouth. He was also subject to 
frequent attacks of sore throat. 
On examining his condition a bony ridge was found projecting from the left side of the septum, prodding into 
the lower turbinated body on that side, very similar to 
the case just described. 
There was also marked hypertrophy of the middle tur- 
binated bone, which pressed firmly against the septum 
above this region. On the left side there was marked in- 
ferior turbinated hypertrophy, which almost completely 
occluded the nostril. On removal of these abnormal 
conditions the pain disappeared, and there has been no 
return of it since. The general condition, which 
had become much reduced, at once rapidly improved. 
He went back to his work and has had no trouble 
since. 
7 
Mrs. J. K , aged thirty-one, had had nasal catarrh 
and obstructed nostrils for eight years, and during each 
summer hay-fever very severely. Four years previous to 
the time when I saw her, she began to have frequent and 
severe headaches affecting the whole head, but more 
intense over the supra-orbital and frontal regions. She 
had a profuse discharge from the nose. She also had 
tinnitus aurium, but her hearing was not impaired. She 
became unable to use her eyes to read or sew, on account 
of a headache which was immediately brought on. In 
general health she was weak and anaemic. 
On examination of her nasal passage I found both 
inferior and middle turbinated hypertrophy, on both sides, 
obstructing the nostrils anteriorly and posteriorly Most 
of this projection was removed with a snare, and the 
remainder with the galvanic cautery. After some subse- 
quent treatment the nasal stenosis was completely 
removed and nasal respiration became entirely free. The 
headaches disappeared, as did also the sensitive condition 
of the eyes, so that she could read and sew, and use her 
eyes without the slightest discomfort or headache. Her 
general health improved. She began to gain in flesh and 
strength, and during the five years which have since 
elapsed she has remained entirely well, with no return of 
the headache or the hay-fever. 8 
Miss K. C , aged twenty-six. For two years she 
had experienced a great deal of obstruction in the nos- 
trils, with a sensation of pressure about the bridge of the 
nose, sensitiveness of the eyes and lachrymation, pain about 
the head in the temporal and frontal regions, but partic- 
ularly back of the neck. She also had a profuse 
discharge from the nose, and frequent hoarseness. 
On examination the middle and superior turbinated 
bones on both sides were found greatly enlarged and 
pressing firmly against the septum. There was very little 
other trouble found in the nostrils. The inferior turbi- 
nated bodies were not hypertrophied. Pressure over the 
inner wall of the orbit on either side would greatly 
increase the pain on that side of the head. The treatment 
consisted in removing the hypertrophied portions of the 
middle turbinated bodies which pressed against the sep- 
tum. The headaches were at once relieved, as was also 
the sensitive condition of the eyes and the lachrymation. 
Mr. L. H , aged fifty. He had experienced trouble 
in the throat since he could remember. During the past 
four years he had had much obstruction of the nostrils, 
with profuse discharge, and also a severe but dull pain 
and a sensation of pressure about the bridge of the nose, 
with a dull headache extending through the frontal and 
temporal regions. 
On examination of his nose, on both sides there was 
found inferior posterior turbinated hypertrophy. On the 
left side, the middle turbinated body was found enlarged 
and pressing against the septum, while on the right side 
of the septum, along the superior border, there was a 
thick ridge of tissue of a doughy consistency, which was 
pressing against the superior turbinated body on that side. 
The removal of these abnormal conditions in the nose 
resulted in complete relief from the headache and of the 
noticeable symptoms of the nasal difficulty. 
Mrs. J. R , aged forty three. Her throat was sensi- 
tive, and she had been subject to frequent colds in the 
head for several years. During the past three years she 9 
had been subject to headaches, slight at first, but gradu- 
ally increasing in severity. They were confined mainly 
to the frontal regions, but at times severe pains, which 
she considered neuralgic, would extend throughout the 
whole region of the scalp. She had also more or less 
stoppage of the nose, and was obliged to sleep with her 
mouth open. In the morning her mouth would be dry 
and parched. She also suffered from a great deal of irri- 
tation about the throat and was frequently hoarse. 
On examination of the nose there was found, on the 
right side of the septum, an exostosis projecting against 
the middle and superior turbinated bodies, which were 
very sensitive to the slightest touch of the probe. There 
was also some inferior posterior turbinated hypertrophy on 
both sides. There was a pad of hypertrophied tissue along 
the upper border of the septum, on the left side, pressing 
against the middle turbinated bone. The turbinated 
hypertrophies were removed, the hypertrophies of the sep- 
tum, and the bony projection.. With the necessary sub- 
sequent treatment the nasal difficulty was entirely relieved 
and the headaches wholly disappeared. 
Mrs. D. G , aged forty-two. For several years she 
has had more or less obstruction of, and discharge from, 
the nostrils, attended with very severe headaches. She 
was subject to frequent attacks of cold in the head, which 
would at once bring on a headache. These attacks were 
considered to be of a congestive nature. The headaches 
at first were slight, but afterward they became much more 
severe and persistent. Sometimes a severe attack would 
be attended with nausea and vomiting. Occasionally 
these attacks would supervene during some change in the 
weather, and without the evidence of a cold. She was 
very sensitive to the inhalation of dust or damp air, which 
would bring on a headache. Her general health was 
much impaired. Examination of her nose revealed a 
firm hypertrophy or enlargement of the middle turbinated 
body, which pressed against the septum. There was also 
some inferior posterior turbinated hypertrophy on both sides, and a pad of thick, soft tissue on the right side of 
the septum, near the upper portion, pressing against the 
middle turbinated body on that side. These abnormal 
conditions of the nose were removed. The headaches 
and attacks of nausea speedily disappeared, and, with the 
administration of tonics of bark and iron, she soon 
became restored to a condition of vigorous health. 
As to the etiology of headaches, it may be said that 
those which have their exciting cause in the nose are reflex 
in character. This is a self-evident fact, for the reason 
that the manifestation of pain is at a point more or less 
remote from its exciting cause in the nose. 
The exceptions to this statement are where the pain 
occurring directly over the frontal sinuses is due to 
disease of these sinuses; or to the accumulation of secre- 
tions or of mucous discharges in these sinuses caused by 
obstructive swelling at the opening of these sinuses, or to 
hypertrophic rhinitis; or to the direct extension of dis- 
ease from the nasal cavity to the meninges and brain. 
Such extension, however, very rarely occurs. 
It may occur, nevertheless, when the cribriform plate 
and the upper portion of the lateral masses of the eth 
moid bone are quite extensively diseased and undergoing 
necrosis; or it may take place through the communica- 
tion of the lymphatics of the nasal mucous membrane 
with the supra orbital and sub-arachnoid spaces. It has 
been demonstrated that by injecting fluids into the latter 
spaces with sufficient force, such fluids can be made to 
pass through the lymphatic canals to the surface of the 
mucous membrane. Therefore, if these nasal lymphatics 
become obstructed, it is not impossible that more or less 
pressure might be made on the cerebro-spinal fluid. 
The exciting cause of nasal headache is an irritation of 
the terminal nerve-filaments in the nasal chambers, which 
excites an undue activity in the communicating ganglion, 
and from which an irritation is reflected to the terminal 
filaments of other communicating nerves. This undue activity of the sympathetic ganglia also causes a dilatation 
of the smaller vessels and the capillaries, and a greatly 
increased vascularity of the part takes place, which, being 
associated with the head pain, is recognized as a conges- 
tive headache. Sometimes, when the irritation is great, 
the congestion will be intense. The vessels of the scalp 
will be full and bounding. There is often more or less 
hypersesthesia of the scalp, with a sensation of heat at the 
spot where the pain is most intense, or a sensation as if 
a nail were driven into the scalp, a “ clavus ” which the 
patient will sometimes instinctively indicate by a gesture. 
It is in this manner that other well-recognized headaches, 
due to irritation reflected from distant parts and organs, 
are caused; as, for instance, those due to uterine irrita- 
tion, and most commonly expressed by a vertex-pain; 
those excited by derangements of the stomach, causing 
irritation of the gastric plexus of the sympathetic, and 
reflected to the frontal region; and those due to eye- 
strain, and manifested by pain in the region of the orbit 
and temple. 
In the last case mentioned the irritation is caused by 
the effort of the ocular muscles to adjust themselves so 
as to overcome a defective accommodation, and as soon 
as the irritation is removed by ceasing to use the eye, or 
by the use of properly adjusted glasses, the consequent 
headache ceases. The frequent occurrence of the depend- 
ence of severe headaches on defective accommodation of 
the eye is shown by the number of reports of such cases 
that have been, during the past few years, scattered 
through our medical literature. Many cases of eye- 
trouble due to disease in the nose are also reported. 
In the nose, the irritation is occasioned by some abnor- 
mal condition which brings together parts that normally 
should be separate, and produces more or less pressure 
between them. 
In no case of headache, either temporary or persistent, 
excited nasal irritation, have I failed to find the irrita- 
tion to be due to such pressure in some portion of the 12 
nasal chambers. I should except polypoid or other 
growths in the nose, which will produce pressure, and fre- 
quently severe headaches, but in such cases the parts are 
forcibly separated. This" pressure may be constant or 
only during the period of temporary engorgement of the 
soft parts, which brings them forcibly together or against 
the septum. There may be an exostosis of a turbinated 
bone prodding the septum, or a firm hypertrophy of a tur- 
binated body pressing against it; or the septum may be 
much deflected, or there may be a bony ridge or sharp 
spur projecting from it, prodding a turbinated body. 
When one wall of a nasal passage comes in contact 
with its opposite wall, sooner or later the resulting irrita- 
tion causes a sensitiveness and thickening of the tissues. 
It is not uncommon that a sensation of fullness is felt 
at the base of the nose and about its bridge, associated 
with more or less head-pain, due to an enlarged middle 
turbinated body wedged in tightly against the septum. 
I have also not infrequently found a pad, or oval mass, 
of tissue located on the septum, near its upper border, 
opposite to and pressing against the middle or superior 
turbinated body. These are almost always very sensitive 
to irritation, and in persons subject to hay-fever they are 
extremely so. 
The character of the pain varies from a dull, heavy 
ache, like that from undue pressure, to a sharp pain, 
like that characteristic of neuralgia. The pain also may 
be intermittent and more or less transient, recurring at 
frequent and, it may be, regular intervals, or it may be 
persistent, or nearly continuous. 
In the latter case it is, as a rule, due to a constant 
pressure between parts that are found to be bony or com- 
posed of more or less firm tissue ; while in cases of tran- 
sient pains the pressure is between soft tissues, and on the 
subsidence of the engorgement, the parts become sepa- 
rated and the pain disappears. In other words, when 
there is constant pain there is a correspondingly constant pressure, and in temporary attacks of pain the pressure 
is correspondingly temporary. 
Certain atmospheric conditions will excite headache. 
It is usually when there is a low temperature and low 
barometer, with the air surcharged with moisture—a con- 
dition that causes these diseased nasal tissues to become 
engorged and also distended by the absorption of water 
from the atmosphere. 
Various conditions of the body have an influence on the 
nose and cause reflected headaches. Gastric and hepatic 
disturbances and a plethoric condition of the system will 
not only produce a fullness of the cerebral vessels by sym 
pathetic irritation, but also a distention of the cavern- 
ous sinuses of the nose, thus producing intra-nasal 
pressure. 
The connection between the nose and stomach is often 
experienced by those who indulge in wine dinners, and 
tax their stomachs beyond their normal capacity with pate, 
defoie gras and other like substances of difficult digestion ; 
for it is rarely that they escape a cold in the head and a 
matutinal headache. Persons who have organic de- 
rangements in the nasal passages can rarely indulge 
to excess in eating, drinking, or nervous excitement 
without exciting a coryza and an associated head- 
ache. 
It is to be noticed in those cases in which an engorged 
condition of the nasal passages is associated with a head- 
ache, that the pain is mainly located in the region where 
a pain is experienced by the same person when suffer- 
ing from what he considers a purely catarrhal headache. 
In the latter case the relation between cause and effect is 
recognized by the individual, but in the former instance 
the pain is attributed to some other cause than that 
existing in the nose. 
The location of the pains in the head has no constant 
relation to the disease nor to its seat in the nose, and it has 
no such relation to the distribution of the nerves or blood- vessels. As I have pointed out in a previous paper,1 an 
irritation reflected from the nose (or from any other part, 
as the case may be) is, like the electric current, reflected 
always in the direction of the least resistance. It may be 
reflected in one direction at one time, and in another at 
another time. Therefore, from the same region in the 
nose the pain may be reflected to the vertex, to the occi- 
put, to the parietal, temporal, or frontal region ; or it may 
be spread out over the whole surface. 
In some cases, as we would naturally expect, when the 
abnormal condition in the nose is confined to one side, 
we have a hemicrania on that side ; but this is not always 
true, as shown by some of the cases cited. 
Notwithstanding the fact that the location of the pain 
in the head bears no constant relation to the location of the 
disease in the nose, it is observed that from certain por- 
tions of the nasal chamber pain is more often reflected to 
particular regions of the head than to other regions. Thus 
from the inferior turbinated body and lower portion of 
the septum the pain is most often reflected to the lower and 
posterior portion of the temporal, parietal, and occipital 
bones.2 The pain reflected from the region of the middle 
turbinated bone is commonly referred to the temple, some- 
times invading the whole region from the nose to the 
parietal eminence, and extending to the vertex; while pain 
reflected from the region of the superior turbinated bone 
is commonly felt in the frontal and supra-orbital region. 
i Hay Fever ; An analysis of forty-four cases treated by the writer, 
together with results of treatment, New York Medical Journal, 1887, 
vol. xlvi., p. 225. 
z Pain may be reflected from this region in other directions. A little 
more than a year ago a gentleman, aged forty, consulted me in regard 
to a naso-pharyngeal affection that troubled him very much. He also 
complained of a continuous dull pain in the upper portion of the left 
side of his chest, which greatly annoyed him, lest il were due to some 
disease of the lung. I examined the chest, but could not And the 
slightest evidence of disease there. In his left nostril there was a bony 
ridge projecting from the left side of the septum, near its lower border, 
and pressing into the left inferior turbinated body. On the removal 
of this bony ridge in the treatment of his nasal disorder the pain in his 
chest entirely disappeared, and there has been no return of it since. Sometimes the pain will completely surround the eye, or 
be centred in the back of the eyeball.1 
In the diagnosis of headaches it is, therefore, evident 
that the dependence of persistent and so-called congestive 
headache upon abnormal conditions of the nasal pas- 
sages is sufficiently frequent to call for a careful examin- 
ation of these passages. In fact, in all cases where there 
is not an unquestionable relation of cause and effect 
between some other local or general disease and the head- 
ache, the nasal passages should be interrogated, even in 
the absence of urgent or distinctive symptoms of nasal 
disease. 
It is too frequently the case that a well-pronounced 
nasal trouble is looked upon as nothing more nor less 
than an ordinary “ nasal catarrh ; ” while the headache 
that results from the disease in the nose is considered to 
be chronic neuralgia, as was the case with some of the 
patients whose cases 1 have reported, and the patient is 
teased for months, or years, until general debility, ner- 
vous prostration, or a neurosis is developed. 
The necessity for an exhaustive study and careful ex- 
amination of each particular organ that may, by any 
possibility, contain the exciting causes of any obscure 
neurotic affection, cannot be better illustrated than by 
the affection under consideration. 
i Since this paper was read, a lady, aged fifty-five, was referred to 
me for treatment for a frequently recurring slight epistaxis from the 
left nostril, which I found to be caused by a small ulcer near the upper 
portion of the triangular cartilage. She also suffered from periodic 
headaches, occurring regularly every three weeks. The pain was con- 
fined to the right supra-orbital region, surrounded the right eye, and 
extended in behind the eye. During the two weeks previous to the 
time I saw her, she had also had divergent strabismus of this eye. Ex- 
amination of the right nostril showed a rounded pad of hypertrophied 
tissue on the right side of the septum, near the upper border, opposite 
the superior turbinated body. It completely filled the passage at that 
place and pressed against the superior turbinated body. Pressure with 
a probe against this spot was referred to the supra-orbital region, 
while pressure against the superior turbinated bone caused a sharp 
pain in the back of the eyeball. On taking away this pad of hyper- 
trophied tissue, pressure against the superior turbinated bone was 
removed, and there has been no headache or pain in the eyes since, and 
the strabismus has disappeared. In case the headache is associated with pronounced 
nasal irritation, and there is an absence of any other pro- 
nounced cause, such as gastric disturbance, eye-strain, 
uterine and renal disease, rheumatic and lithaemic affec- 
tions, or the effects of drugs, such as cocaine, and some- 
times quinine, we have presumptive evidence that the 
headache originates in the nose. 
Further evidence we should seek for, by carefully 
examining the nasal passages. If we see evidence of one 
or more of the various diseased conditions in the nose, 
already described, that may be the cause of headache, we 
should carefully explore the part with a probe. Usually 
the slightest touch of the probe against the offending part 
will provoke the characteristic head-pain. This connec- 
tion is more pronounced during the exacerbation of the 
pain than during the period when the nasal iritation is in 
a condition of comparative quiescence. 
Dr. Harrison Allen1 has called attention to the effect 
of pressure upon the inner wall of the orbit; the pain 
that is caused thereby being due to the pressure of the 
anterior end of the middle turbinated bone against the 
septum. This pain, he observes, is reflected on a line 
from this point to the temple, and sometimes to the 
parietal eminence ; while pressure of the entire bone 
against the septum will give rise to vertex-pain. 
The treatment of headaches dependent on intra-nasal 
disease consists in the removal of the cause and the res- 
toration of the nose to a normal condition. The con- 
ditions which we may have to deal with as possible causes 
of cephalic pain have been described under the head of 
etiology. 
Dr. Glasgow,2 of St. Louis, has called attention to the 
immediate relief given in the case of “ congestive head- 
i On the Headaches which are Associated Clinically with Chronic 
Nasal Catarrh. Medical News, 1886, vol. xlviii., p. 290. Phila. 
s On Central Measures for the Relief of Congestive Headaches. 
New York Medical Journal, 1887, vol. xlvi., p. 260. aches ” by the abstraction of blood from the cavernous 
sinuses of the nose. 
He observed that, during a congestive headache, the 
cavernous bodies of the nose were always in a condition 
of intense hypersemia, and that on the abstraction of 
blood from these bodies the hypersemia disappeared and 
the headache subsided. The abstraction of blood was 
accomplished by simply puncturing the cavernous bodies 
with a needle, and the flow of blood was proportionate to 
the amount of engorgement—from a drachm to several 
ounces. This also illustrates very clearly the dependence 
of headache on intra-nasal pressure. 
The prognosis in regard to the result of the treatment 
and the relief of the pain will depend entirely on the 
accuracy of the diagnosis and the care with which the 
indications are carried out 3 for, when the cause is gone 
the symptoms will disappear sublata causa tollitur 
effectus.