OpenHealth Q&A

Ongoing Facial Pressure and Breathing Difficulties for Four Months

Greetings! I’m a 24-year-old female, currently prescribed nortriptyline (as mentioned earlier) and using a Fostair inhaler. I’m a nonsmoker, my height is 5'6", and I weigh 120 pounds. As indicated in the title, I’ve been dealing with pressure on the right side of my face—specifically above my eyebrow, extending to my temple, along the bridge of my nose, and beneath my eyes—for approximately four and a half months. This discomfort is accompanied by significantly impaired airflow through my left nostril. I’m feeling quite frustrated, which is why I’ve decided to share my experience here. The first instance of the facial pressure began on March 21, initially leading me to suspect a sinus infection. By March 22, I developed a debilitating headache and nausea, alongside the pressure, and also caught a cold. While the cold symptoms subsided within about three days, the headache, pressure, and nausea lingered. I found it difficult to breathe through my nose, assuming this was merely due to congestion. Following this, I was prescribed antibiotics (penicillin) and a nasal spray, but after completing the penicillin course and switching to doxycycline, I noticed no improvement. Fortunately, around May 1, the intense headache and nausea subsided. Subsequently, I was referred to an ENT specialist, but a CT scan of my sinuses revealed no issues apart from a deviated septum on the left side. An allergy test yielded no concerning results either. After that, I was sent to a neurologist. The week before my appointment with the neurologist, I noticed some numbness in my arms, a symptom I had previously only experienced during migraines (which I’ve had three in the past, all accompanied by aura and numbness prior to the headaches). The neurologist concluded that I was experiencing a migrainous phenomenon. He conducted an MRI of my brain, which appeared normal, and subsequently prescribed nortriptyline; I have been on it for eight weeks now. Unfortunately, the pressure on the right side of my face persists, though the numbness has dissipated after only a brief episode. As an avid runner, I’ve also observed that my heart rate during runs has become excessively elevated. For instance, my average heart rate during runs that used to be around 155 bpm has shot up to 180 bpm. Despite this, both my ENT and neurologist attribute my issues solely to migraine-related symptoms and the deviated septum, but I recall a time when I could breathe freely through my left nostril. Additionally, I’ve experienced noticeable clicking and crackling sensations in my face when I manipulate my soft palate. Although this has improved, it still occurs occasionally and is audible to those nearby. I am curious if others believe these diagnoses are accurate. Although I am not a medical professional, I struggle to distinguish the connection between my breathing difficulties and the pressure sensation, as they emerged simultaneously. I feel somewhat helpless at this point, especially considering that my insurance no longer covers migraine-related care since it has been classified as a chronic condition, leaving me uncertain about the next steps to take.

Answers (1)

8/6/2025, 11:21:13 AM

OpenHealth AI

It's understandable to feel frustrated with ongoing facial pressure and breathing difficulties, especially when they significantly impact your daily life. The symptoms you describe can indeed be interconnected, and addressing them requires a careful approach.

Main Points:

1. Your facial pressure and nasal airflow issue may be linked to a sinus-related condition or migraine-related symptoms.
2. The deviated septum may contribute to your breathing difficulties, but there could be other underlying factors.
3. Increased heart rate during runs and sensations in your face warrant further investigation.

Explanation:

You’ve experienced facial pressure predominantly on one side, blood flow issues, and breathing difficulties, compounded by a past of headaches. It’s important to understand that the pressure might be a result of sinus congestion, even though the CT scan didn’t show significant issues. The deviated septum could potentially impede airflow, but it might not be the sole cause. Migraines can also cause referred symptoms like facial pain and numbness. The elevated heart rate during exercise needs attention, as it could be influenced by anxiety related to your symptoms or other physiological factors.

Next Steps:

1. Monitor Symptoms: Keep a daily log of your symptoms, noting the intensity of facial pressure, nasal airflow, headache occurrences, and exercise heart rate. This chronicling can help identify triggers or cycles in your symptoms.

2. Breathing Techniques: Practice nasal breathing exercises to enhance airflow through your left nostril. This could also include using saline nasal sprays to keep nasal passages moist and clear.

3. Evaluate Medication Effects: Since you have been on nortriptyline for eight weeks, consider tracking any changes in your symptoms to discuss with your physician. The medication may require adjustment if symptoms persist.

4. Discuss Further Evaluation: If issues continue, inquire about revisiting your ENT specialist for a more detailed assessment of possible sinus involvement despite the CT scan results. You might also ask about options for nasal surgery for the deviated septum if it's contributing to your breathing difficulties.

5. Focus on Physical Health: With your heart rate increasing during runs, consider cross-training with lower-intensity exercise until you assess your cardiovascular response. Stay hydrated and follow a balanced diet to support overall health.

6. Seek Support: Look into support groups or online communities for chronic pain and migraine sufferers. Sharing experiences can provide comfort and potential coping strategies.

If symptoms worsen or new symptoms appear, remain vigilant and advocate for a thorough review of your case with your healthcare providers. It's important that you feel empowered and supported in managing your health journey. Please remember, you’re not alone in this process.