Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Nasal Congestion And Pain Above Eyebrows
Question: Hi, how are you? So, my 17-year old daughter has had odd head pressure for years (5-7 years). All the pressure/pain is right above her eyebrows. She happens to have cysts in that exact spot, which come and go. We had the cysts injected the summer and the cysts disappears for awhile, but the pain/pressure was still there. We then went to an ENT physician - started out with sinus meds that did nothing. She had a CT Scan a couple of weeks ago, and didn't show much more than a deviated septum. Below is a typical morning for her: Evening before bed: pressure on right side, above eyebrow
Morning/wake up (7am): head weird, sore feeling on left side above eyebrow, left nostril stuffed up, dry throat
Wash face, drink iced coffee - feeling better (in school)
9:06AM: feel pressure coming again - left side above brow (typical place) and bump/cyst larger; right side slight pressure
9:12AM: have to close eyes, head down, press on cysts/bumps
Okay for awhile
10:34: pressure comes back - left side pain, left side tingly back of head
10:43: also left side of face tingly - left cyst above brow harder now
10:45: really tired now - hard to open eyes
10:46: Have to sleep while pressing on left side above brow; right side not a problem
11:05: forced to get up; stuffed left nostril, eyesight blurry in left eye, head still hurts, eye is half closed, can’t see straight
Our pediatrician next steps recommendation is a pain management clinic (at MGH). What do you think? Have you any experience with this? Thanks
Morning/wake up (7am): head weird, sore feeling on left side above eyebrow, left nostril stuffed up, dry throat
Wash face, drink iced coffee - feeling better (in school)
9:06AM: feel pressure coming again - left side above brow (typical place) and bump/cyst larger; right side slight pressure
9:12AM: have to close eyes, head down, press on cysts/bumps
Okay for awhile
10:34: pressure comes back - left side pain, left side tingly back of head
10:43: also left side of face tingly - left cyst above brow harder now
10:45: really tired now - hard to open eyes
10:46: Have to sleep while pressing on left side above brow; right side not a problem
11:05: forced to get up; stuffed left nostril, eyesight blurry in left eye, head still hurts, eye is half closed, can’t see straight
Our pediatrician next steps recommendation is a pain management clinic (at MGH). What do you think? Have you any experience with this? Thanks
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Based on your description I would give two possible explanations to the symptoms.
One would be sinus congestion. It would be compatible with the description of stuffed nose and pressure pain over the eyebrow, in the setting of a predisposing factor like deviated septum. While it may not be infected, not sinusitis, and drainage may not be fully blocked, still episodes of congestion can cause the fullness you describe. I wonder if she takes anything for the nose congestion. Perhaps antihistamines and decongestants, or even simple measures such as steam therapy 2-3 times a day may help. Maybe even surgery for correction of the deviated septum may be considered if such conservative measures do not seem to work.
Other possibility might be damage to the supraorbital nerve which supplies that area from those cysts you describe, which may leave some permanent damage to the nerve with abnormal sensations. However that doesn't explain the stuffed nose and eye changes, so I would sway much more towards the first possibility.
As for asking for an opinion at MGH, well if possible I would take that. MGH is one of the most well know clinics, not only in the US, but also in Europe where I live, so would be in good hands.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Based on your description I would give two possible explanations to the symptoms.
One would be sinus congestion. It would be compatible with the description of stuffed nose and pressure pain over the eyebrow, in the setting of a predisposing factor like deviated septum. While it may not be infected, not sinusitis, and drainage may not be fully blocked, still episodes of congestion can cause the fullness you describe. I wonder if she takes anything for the nose congestion. Perhaps antihistamines and decongestants, or even simple measures such as steam therapy 2-3 times a day may help. Maybe even surgery for correction of the deviated septum may be considered if such conservative measures do not seem to work.
Other possibility might be damage to the supraorbital nerve which supplies that area from those cysts you describe, which may leave some permanent damage to the nerve with abnormal sensations. However that doesn't explain the stuffed nose and eye changes, so I would sway much more towards the first possibility.
As for asking for an opinion at MGH, well if possible I would take that. MGH is one of the most well know clinics, not only in the US, but also in Europe where I live, so would be in good hands.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, Dr. Taka. As an FYI the cysts are external to the sinuses - they didn't not come up on CT scan. Not sure if that makes a difference. She has noticed that when she has a cold/stuffed nose, her head hurts less. She took Flonase for a few months, based on the recommendation of the Mass Eye and Ear ENT, but it didn't help at all.
Is there anything that can be done for a deviated septum beyond surgery. She feels like there is a flow issues up there. The problem overall ebbs and flows daily. It is never not there.
We will go to the MGH headache clinic, but we won't be able to go for about a month because she has so much going on. Also, a few other things. She is a singer. Her throat gets incredibly dry, and she is constantly hydrating. When she exercises, she has to drink every few minutes. Lastly, and probably not related but when she runs on a treadmill (at 6.5), her breathing sounds really strange - almost gasping for breath. She has always been a dancer, and breathing never a problem, but over the past year, she started running. Thanks for any thoughts you might have...
Is there anything that can be done for a deviated septum beyond surgery. She feels like there is a flow issues up there. The problem overall ebbs and flows daily. It is never not there.
We will go to the MGH headache clinic, but we won't be able to go for about a month because she has so much going on. Also, a few other things. She is a singer. Her throat gets incredibly dry, and she is constantly hydrating. When she exercises, she has to drink every few minutes. Lastly, and probably not related but when she runs on a treadmill (at 6.5), her breathing sounds really strange - almost gasping for breath. She has always been a dancer, and breathing never a problem, but over the past year, she started running. Thanks for any thoughts you might have...
Brief Answer:
Read below.
Detailed Answer:
I am sorry for answering a bit late....I usually get an SMS when there is a follow up question, not sure why I didn't receive one in your case....noticed only now.
I had already assumed that the cysts were outside of the sinus, that is why I mentioned the possibility of supraorbital nerve damage which passes outside the sinuses.
I am afraid there is not much that can be done for deviated septum apart from surgery as it is a mechanical problem, so either it is tried to facilitate drainage through antihistamines and decongestants, or when that is not possible and symptoms affect quality of life, it is corrected surgically.
As for the dry throat. One possibility is related to the same congestion issue above, which can lead to secretions running down the back of the throat during the night and irritation of the throat. One other possibility might also be gastroesophageal reflux disease irritating the throat, when there is back flow of the stomach content, usually with other signs such as burning feeling behind the chest, episodes of regurgitation with sour taste in the back of the throat etc.
It could also be an allergic issue, similar to asthma. It is common for allergic issues to affect both the nasal and sinus cavities as well as lower airways. However can not be said that easily, would need more tests on that regard such respiratory capacity, chest imaging etc.
Let me know if I can further assist you.
Read below.
Detailed Answer:
I am sorry for answering a bit late....I usually get an SMS when there is a follow up question, not sure why I didn't receive one in your case....noticed only now.
I had already assumed that the cysts were outside of the sinus, that is why I mentioned the possibility of supraorbital nerve damage which passes outside the sinuses.
I am afraid there is not much that can be done for deviated septum apart from surgery as it is a mechanical problem, so either it is tried to facilitate drainage through antihistamines and decongestants, or when that is not possible and symptoms affect quality of life, it is corrected surgically.
As for the dry throat. One possibility is related to the same congestion issue above, which can lead to secretions running down the back of the throat during the night and irritation of the throat. One other possibility might also be gastroesophageal reflux disease irritating the throat, when there is back flow of the stomach content, usually with other signs such as burning feeling behind the chest, episodes of regurgitation with sour taste in the back of the throat etc.
It could also be an allergic issue, similar to asthma. It is common for allergic issues to affect both the nasal and sinus cavities as well as lower airways. However can not be said that easily, would need more tests on that regard such respiratory capacity, chest imaging etc.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka: Thank you for your thoughtful answers. The other additional information is that her head problems are alleviated with congestion from a cold. Are you suggesting that allergy testing might be worthwhile. As an FYI, the deviated septum was never a cause for alarm. I feel like I need to get the notes on the CT Scan - I had two ENT's look at it and neither found anything too concerning. Thank you.
Brief Answer:
Read below.
Detailed Answer:
Hello again. When you described her daily routine earlier it seems that stuffed nose is a common daily occurrence, tough to separate it from the pressure headache. Your description of getting up in the morning with sore feeling on left side above eyebrow, left nostril stuffed up, dry throat corresponds to that, as I said secretions running down the back of the throat can irritate it. So it can not be considered a passing flu, a cause must be sought, septum deviation is a possible cause which is why I suggested it, if the doctors do not think that is enough as you say then an allergic background must be considered.
Since she is a young individual if she has breathing difficulties as you report a cause must be sought, may turn out to be nothing important at the end, anxiety at times may mimic such breathing issues, but some respiratory tests should be made to verify indeed if there is diminished respiratory function and if confirmed other tests for the cause, I mentioned allergies as it can join both upper airway and lower airway issues.
If such issues are excluded by your doctors, the second hypothesis I suggested of nerve damage may be considered, in that case a trial of preventive treatment with amitriptyline or gabapentine may be considered (although I am not very enthusiastic of using such long term treatments in a young patient unless symptoms really affecting her life).
I hope to have been of help.
Read below.
Detailed Answer:
Hello again. When you described her daily routine earlier it seems that stuffed nose is a common daily occurrence, tough to separate it from the pressure headache. Your description of getting up in the morning with sore feeling on left side above eyebrow, left nostril stuffed up, dry throat corresponds to that, as I said secretions running down the back of the throat can irritate it. So it can not be considered a passing flu, a cause must be sought, septum deviation is a possible cause which is why I suggested it, if the doctors do not think that is enough as you say then an allergic background must be considered.
Since she is a young individual if she has breathing difficulties as you report a cause must be sought, may turn out to be nothing important at the end, anxiety at times may mimic such breathing issues, but some respiratory tests should be made to verify indeed if there is diminished respiratory function and if confirmed other tests for the cause, I mentioned allergies as it can join both upper airway and lower airway issues.
If such issues are excluded by your doctors, the second hypothesis I suggested of nerve damage may be considered, in that case a trial of preventive treatment with amitriptyline or gabapentine may be considered (although I am not very enthusiastic of using such long term treatments in a young patient unless symptoms really affecting her life).
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Read below.
Detailed Answer:
I wouldn't want to alarm you, I meant to check about lower airways issues if there is breathing difficulties in activities which used to be normal to her. If it is only when performing at high levels, at extreme exertion, then shouldn't worry too much.
Wishing you good health.
Read below.
Detailed Answer:
I wouldn't want to alarm you, I meant to check about lower airways issues if there is breathing difficulties in activities which used to be normal to her. If it is only when performing at high levels, at extreme exertion, then shouldn't worry too much.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What kind of allergy coukd this be? It isnt a seasonal situation, and unlikely to be food related. Thanks.
Brief Answer:
Read below.
Detailed Answer:
Hello again.
Allergic agents which can be related to rhinitis (nasal cavity inflammation) are innumerable. Seasonal agents like pollens are a common cause but not the only one. Indoor allergens like house dust mites, molds are two other common causes. At times a specific cause is difficult to identify though, allergy tests include only the most common ones.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
Hello again.
Allergic agents which can be related to rhinitis (nasal cavity inflammation) are innumerable. Seasonal agents like pollens are a common cause but not the only one. Indoor allergens like house dust mites, molds are two other common causes. At times a specific cause is difficult to identify though, allergy tests include only the most common ones.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
si forgettibg about seasonal stuff, what you wrotewas very interesting bc 2 of my kidsseems to get worse while at the same high school. My son is in college now and dorsnt get the ill feeling. Interesting-what do peopme fo for the nonseasonal allergens? My house has a lot of floors abd is moldfree.
Brief Answer:
Read below.
Detailed Answer:
What you say about your son having similar issues before going to college does raise the issue of possible allergens like house dust mites or molds at school. However every hypothesis needs to be confirmed which is attempted to be done initially through allergy skin tests for common specific allergens.
Afterwards if any such agent is identified if possible measures to avoid it are taken as well as medication when necessary.
Read below.
Detailed Answer:
What you say about your son having similar issues before going to college does raise the issue of possible allergens like house dust mites or molds at school. However every hypothesis needs to be confirmed which is attempted to be done initially through allergy skin tests for common specific allergens.
Afterwards if any such agent is identified if possible measures to avoid it are taken as well as medication when necessary.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
