Posterior Nasal Nerve Ablation for Treatment of Chronic Migraine

Background The posterior-lateral nasal cavity has been used as a target for locoregional anesthetic block for primary headache. Anecdotal observations of improved migraine frequency and severity in patients treated with radiofrequency ablation for rhinitis have suggested the potential of this treatment for chronic migraine. Objective To explore the impact of impedance-controlled posterior nasal nerve radiofrequency ablation on headache frequency, symptoms, and quality of life in adults with chronic migraine. Methods This is a prospective, single-arm, multicenter, feasibility clinical study of bilateral impedance-controlled posterior nasal nerve radiofrequency ablation in adults with chronic migraine with or without chronic rhinitis symptoms. Participants completed follow-up visits at 2, 4, and 6 months after the procedure. Daily headache logs were completed. Outcome measures included mean monthly migraine headache days (MMHD), 50% responder rate (MMHD-50), mean monthly headache days, Headache Impact Test (HIT-6), Migraine-specific Quality of Life Questionnaire (MSQ), and Sinonasal Outcome Test (SNOT-22). Results Six investigational centers enrolled 24 participants with 21 participants completing the 6-month follow-up. The MMHD change from baseline was –5.2, –6.1, –7.1, –7.3, –7.5, and –6.0 at 1, 2, 3, 4, 5, and 6 months, respectively (all p <0.001). The MMHD-50 responder rate ranged from 58.3% to 77.3%. Mean monthly headache days were significantly reduced from baseline for each month ( p <0.0001). Reductions from baseline for the HIT-6 ranged from –14.2 to –16.5, with 17 of 21 participants (81%) achieving a minimum clinically important difference in HIT-6 at 6 months. Statistically significant improvements ( p <0.001) were observed at all time periods for the overall MSQ score and total SNOT-22 score. Conclusions A single bilateral treatment of impedance-controlled radiofrequency ablation of the posterior nasal nerves was associated with significant improvement in migraine frequency, quality of life, and migraine-related burden through 6 months after the procedure in adults with chronic migraine.