Many people suffer from headache, nasal congestion, stuffiness and facial pressure on a regular basis.  Some have suffered for years without getting properly diagnosed.  In this article, Dr. Larry Weiss discusses the causes of headache, congestion and facial pressure – why is it happening and what can be done?

In the thirty plus years of my practice as an Ear, Nose, and Throat (ENT) doctor, it is literally every day that I see patients with complaints of headache, nasal congestion, stuffiness, and facial pressure. Some have suffered for years without getting properly diagnosed.  If you find yourself or a loved one in this situation, then please read on as we discuss the causes of headache, congestion and facial pressure – why is it happening and what can be done?

Let’s say a person has chest pain. What can cause that? It could be a heart problem, or possibly a lung problem or maybe they took a blow to the chest.  Clearly, there are multiple things can cause similar symptoms.  Similarly, from the neck up, multiple things can cause stuffiness, facial pressure, and nasal congestion.  So how do we figure out what is it that’s bothering you, why is it bothering you and what can we do to help you?

There are three common conditions that can show similar symptoms of stuffiness, pressure, facial pain, and congestion. I call them triple “A” – allergy, atypical migraine, and anatomy.  How do we figure out which of these is the root cause for their problems when any of these three can cause similar symptoms?  Here are some of the differences that help us determine the real problem.

Allergies often present with sneezing, itchy, watery eyes. Allergies themselves don’t cause yellow or green drainage and they don’t cause headaches.  Atypical migraine can certainly cause stuffiness, but it’s also going to cause dizziness and it can cause pressure and pain on the side and the back of the head where there are no sinuses. Finally, when people have a real sinus problem, usually they’re going to talk about having persistent, frequent yellow green yucky drainage and cough.

So how do we figure out what’s bothering the person and why it’s happening? More often than not, just by listening to the patient and hearing their story, we’ll know if it looks like migraine or allergy or a sinus problem due to their anatomy.  Sometimes it can be a combination of these.  Once we listen to the patient’s symptoms and get a good idea of what’s going on, then it comes time for the examination.

A big key to trying to help people who may have migraine is knowing that there are specific points on the skull where people will be tender, where they have migraine. There’s a nerve where the eyebrow meets the nose.  There’s one on the temple above the cheekbone. And there’s one in the back of our head. When people don’t have migraine, you can push all day in these spots and they’ll be fine, but when a person has migraine and you push on those spots, they’ll be like, whoa, get off please right now – that’s a great way to know if a person has migraine or not.

How to tell if somebody has a true sinus problem? Well, that’s going to require a good examination with what’s called a nasal endoscope where we take use the scope to see inside the individual’s nose and by knowing one’s anatomy, we can tell is there an obstruction of the pathway to the sinuses that’s preventing the proper ventilation and drainage of the sinuses. Most people, when they have sinus problems, it’s due to an obstruction of that pathway that’s preventing the proper ventilation and drainage and the mucus is just staying within the sinuses and getting infected. 

Once we have a good idea whether an individual is experiencing a true sinus problem or a migraine syndrome, then we’ll usually get into X-ray studies. If one is suspected of having a migraine syndrome, then we usually get an MRI of the brain. If somebody is suspected of having a true sinus problem, then we’ll usually get a cat scan of their sinuses.

So what do we do once we figure out if it is an allergy problem or a sinus problem or migraine? If the problem is allergy, that’s a chronic autoimmune condition and there is generally not much that can be done to cure the condition.  However, there are many ways that the suffering can be relieved.  The key is find a regimen that works to mitigate the symptoms and then once you do, you stick with it. Does one have to stick with it every single day of the year? Depends on whether one’s a seasonal versus a year long allergy sufferer.

When it comes to migraine, if one had to be a migraine sufferer, this is a great time in the history of the world because there is so much that we can do to help people with migraine. Such that it becomes a very minimal part of their life and our treatment these days greatly improves the quality of individuals lives who suffer with migraine.

If someone has a true sinus problem, very often that’s going to require surgery, because usually that’s due to an anatomy problem that is preventing the ventilation and drainage pathway from being open, which is leading to the person having the recurrent infections.

Many people suffer from nasal congestion, stuffiness, pressure for years and years without getting a proper diagnosis, and certainly without getting proper treatment. If you suffer from persistent headache, facial pressure, congestion and stuffiness, please give us a call at Weiss ENT at 770 971 1533 and we will make sure that we get you properly diagnosed and on the path to feeling better.