Entrapment Neuropathy Causing Persistent Headache Symptoms after Nonsurgical Rhinoplasty

Benjamin M, McGregor A, Yousif S, Shaikh D, Reish RG.

PubMed 33425572 Publisher (DOI)Free full text (PMC)

What this paper says

One patient developed a new headache immediately after a filler based nonsurgical rhinoplasty and the symptoms reversed after an injection of hyaluronidase, an enzyme that dissolves the filler.

Overview

Nonsurgical rhinoplasty with injectable filler has become more common, but headaches or migraine like symptoms after it are barely described. The authors report a single patient and then searched the literature for other cases and for anatomical explanations of migraine. The proposed mechanism is entrapment neuropathy, meaning filler compressing a nerve.

Sections of note

Single case report combined with a literature review.
The patient reported a new onset headache immediately after the injection, and the symptoms reversed after hyaluronidase.
The search identified 147 relevant citations.
Of those, only one individual case report described a migraine headache after hyaluronic acid filler to the nose, also resolved with hyaluronidase.
Most relevant articles focused instead on vascular compromise of nasal tissue and filler entering a blood vessel, which the authors call the most feared complication.
No case series meeting the authors' inclusion criteria existed in the literature.
The authors state a causal link cannot be established from this report.

What it means for a patient

A persistent new headache after nasal filler is documented, though as a rare and poorly described event.
Hyaluronidase reversed the symptoms in this patient, which is possible because hyaluronic acid fillers can be dissolved.
One patient cannot establish cause, frequency or who is at risk.
The larger documented danger from nasal filler in this literature is blockage of blood vessels, not headache.

Why this paper matters

Injectable nose reshaping is marketed as low risk and is performed in large numbers, so the catalogue of its side effects is still being assembled. This paper adds a symptom that had almost no prior description and shows a possible reversal route. How often it happens, and whether nerve compression is the real mechanism, remain unknown.

Terms

Nonsurgical rhinoplasty: reshaping the nose with injectable filler instead of surgery.
Hyaluronic acid filler: a gel injected to add volume, commonly used in the nose.
Hyaluronidase: an enzyme injected to dissolve hyaluronic acid filler.
Entrapment neuropathy: nerve pain caused by a nerve being compressed by surrounding tissue.
Vascular compromise: loss of blood supply to tissue, here from filler blocking a vessel.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Unlabelled: The frequency of nonsurgical rhinoplasty has increased in recent years. The occurrence of headaches or migraine symptoms, and their treatment following nonsurgical rhinoplasty, have been scarcely described in the literature. Here, we present a patient who presented with subjective complaints of a new onset headache immediately after nonsurgical rhinoplasty, with subsequent reversal of her symptoms using hylauronidase. Furthermore, a literature review was conducted to establish a possible anatomical pathophysiologic mechanism of these symptoms seen in this patient.

Methods: A case report of a patient who developed persistent headache symptoms after nonsurgical rhinoplasty, with reversal of symptoms using hylaronidase, is described. A literature review of studies on patients developing headaches or migraine-like symptoms after nonsurgical rhinoplasty was conducted, along with a review of the anatomic causes of migraines.

Results: Of the 147 relevant citations identified in our search, only 1 individual case report describes a patient who developed a migraine headache after undergoing a nonsurgical rhinoplasty via an injection of hyaluronic acid filler. This was promptly resolved with the utilization of a hyaluronidase injection. The majority of the relevant articles in our search focused on the alarming and most feared complication of vascular compromise of the nasal tissue and intravascular embolization. Within the literature, there was no case series of nonsurgical-rhinoplasty-induced migraines taking into account our inclusion criteria.

Conclusions: This article demonstrates the paucity of literature regarding nonsurgical-rhinoplasty-induced headaches. Although a causation effect cannot be linked, our study highlights a rare phenomenon associated with this ever-increasing aesthetic procedure.

Abstract as indexed by PubMed; the article is open access (PubMed Central).