Brief Answer:
Trust clinical symptoms plus MRI

Detailed Answer:
Good evening. I hear these types of complaints a lot in my headache clinic and I can tell you that with or without imaging studies....pressure in the location you describe could only likely be sinus congestion or other pathology related if and only if the patient had symptoms of drainage, fever, or obstructed nasal passages. Add a clear MRI from recently and it lowers the likelihood for me that sinus congestion is at play even more dramatically. I would not expose my patient to more radiation with a CT scan though it is typically considered more sensitive than MR for sinuses....honestly, a CLEAR MRI is pretty solid as imaging goes. Your symptoms are likely referable to some type of Trigeminal terminal branch irritation due to some other phenomenon but not sinus congestion.

I would run standard labs and be sure that chemically you are not suffering from a thyroid problem of some sort at the least....I'd check Vitamin D levels, an ESR, CRP, and perhaps an ANA, maybe a random cortisol level as well....but not much more than that....if you smoke....stop....you don't need it anyways....even if it's not likely the cause of these symptoms....

And if you play football or rugby...make sure you're wearing your helmet! :)

My suspicion for something "dangerous" is as close to zero as it goes....the fact that nausea is an accompanying symptom makes me think of atypical migraine headaches....but then, again, I'm a headache specialist so you can call me bias....but the symptoms clearly fit the definition for an ATYPICAL migraine type of headache since you DON'T HAVE headaches.....go ahead and read that again...no typos....it says exactly what it's supposed to say.

If you get no relief using conservative measures (and please do not let some ENT person convince you that you need to get trephinated for any reason) you should ask to be referred to a HEADACHE SPECIALIST because ATYPICAL MIGRAINE begins to rise closer to the top of my differential list in this setting.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 17 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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Brief Answer:
Other patients with similar symptoms

Detailed Answer:
Thank you for your return response. Your initial statement was that you are feeling a sense of PRESSURE in the upper nasal or septal area to which I responded that I've seen many such complaints. When you qualify it further by stating that it feels as if you were to sneeze or water up the nose then, I can't state specifically that I can recall anybody from my clinic or practice with the specific complaint of sneeze like or water up the nose like sensation. However, no matter how you wish to describe the sensation it is still an aberration of the signals being subserved by some terminal branch or branches of the Trigeminal nerve which is also the nerve believed to be responsible for headaches of the migraine type.

If your chronic underlying infection is NOT in the region of the head or neck then, I don't think it is highly likely it is contributing to your symptoms of this pressure.

Any structural lesion which is greatly than 1 mm. in diameter which is equal to 0.04 inches (pretty small, yes?) would be expected to show up on an MRI scan. I can't say that it would show up without contrast enhancement if it were in fact THAT SMALL.....but certainly something solid and larger to the degree of maybe 5-6mm. even without contrast...especially if it's something which is not anatomically suppose to be there would likely be picked up. Therefore, in my opinion the chance of you have something "pressing" and causing this sensation in terms of a tumor, aneurysm, vascular malformation is extremely small at best.

And therefore, again, I revert back to looking for a cause of irritation to the Trigeminal nerve viz a viz the upper airway tracts which could be either chemical, metabolic, or as I said earlier classifiable as an ATYPICAL MIGRAINE which is considered to be a form of migraine headache which manifests itself in many ways OTHER THAN ACTUAL HEADACHE. A good history and examination by a neurologist well versed in this type of problem or ability to look at the MRI films or direct the radiologist to RELOOK at the MRI films and key on anything that could be irritating the trigeminal nerve from its origin in the brainstem all the way out to the sinuses would be a good next step.

Microadenomas of the pituitary that are stable and being followed do not cause these sorts of symptoms so I would discard that from the mix of possibilities....or at least place it in the least likely category with other things we've already mentioned.

Once again, if I've provided you with useful or timely information on your condition could you do me the favor of CLOSING THE QUERY and including some positive words of feedback with a 5 STAR rating if so moved? Again, many thanks for posing your questions and I'm interested in the outcome of your discovery of this problem.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 43 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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