Numbness/pressure in face

I've had numbness and pressure in my face/head for a week now.  Clear CT Scan eliminated sinus pressure and fluid on brain.  The ER sent me home and said I am a mystery.  The numbness is predominantly on the left side but it shows up on the right as well.  Any clues to what my next step should be?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Headaches can be a primary headache (such as a migraine which is typically a unilateral, throbbing headache that may have nausea, vomiting and/or sensitivity to light and/or sound) or secondary headache (such as from a structural lesion in the brain).

A concerning cause of unilateral headache, usually with neck pain, is a dissection: a small tear in the blood vessels that travel up the neck to the brain. This is often in patients with vascular history but can occur spontaneously in people with certain conditions that affect the blood vessels, after neck trauma, or after chiropractic manipulation of the neck. The pain is often but not always associated with some sort of neurologic deficit as a dissection can often lead to a stroke. A dissection is diagnosed with a specific type of MRI test (MRA with fat saturation) or a CT angiogram.

Other causes of unilateral headache, particularly if you are older than 55 years of age, is a condition called giant cell arteritis or temporal arteritis. This condition is due to an inflammation in the temporal artery and other arteries in the body. Symptoms include one sided headache pain in the temple and jaw that may be triggered by chewing, touching of hair, combing of hair, etc. This condition can be diagnosed by a blood test called an ESR and a biopsy of the artery. It is very important to rule this diagnosis out as it is highly treatable and if left untreated it can lead to vision loss. It is exceedingly rare in people younger than 55, and is more common in even older age groups.

Another potential cause of temple pain is inflammation or arthritis of the temporo-mandibular joint, commonly called the TMJ. This can sometimes occur due to bruxism, biting down at night or during the day, and other stresses to the joint. This is best diagnosed/managed by an orthodontist or an ENT, and treatment includes braces and other dental fixtures and sometimes muscle relaxants, depending on the exact cause.

I should also mention that there are some other forms of headaches that are unilateral that may be associated with autonomic findings such as tearing of eye, redness of eye, running nose, or facial flushing. These types of headaches usually respond to a medicine called indomethacin.

Without further information about your headache, it is difficult to provide you with adequate information. However, it is important for you to understand that if you have not experienced headaches in the past and you are now having new head pains, seeing a neurologist is a good idea, just to make sure there is nothing serious causing this pain. Imaging of the brain and sometimes then neck may be indicated depending on your exact symptoms, your physical examination, and other factors.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[hippychic258]

You are describing Headaches and I think her complaint is numbness and pressure, not a headache.