Chronic Tight Pressure sensation in forehead

[KimSb]

I've been suffering from persistent pressure, tightness in my forehead for several years. Feels like I'm wearing a helmet that's too tight & it's hard to raise my eyebrows. This causes physiological/Neurocognitive symptoms that have greatly effected my functioning. I'm in a 24/7 drunk hangover-like fog. Unlike a headaches or migraine, the symptoms are perpetual with no relief. I've seem multiple I-Disease, Neurologists, Allergist, ENT at a renown academic hospital. The neuroMD did several MRIs & tried the obligatory Elavil, SSRIs, Topamax, Imitrix etc & they made it worse. After a myriad of neg blood tests, multiple normal brain,thoracic,cervical MRIs, EEG & spinal tap, & extended antibiotic/malarial treatment, An allergist said my IgE mold tests were high & he put me immuno injections & antifungals. Neither helped. The allergist said my CT scan is abnormal & shows sinus disease, which he feels may be causing this symptom. CT scan showed the Mastoid air cells were clear and "unremarkable" but showed a deviated septum & turbinate, & a mild membrane thickening of the frontal & max sinus. ENT thought surgery would help my breathing, he wasn't sure it would help my chronic head or pressure. Where do I go from here? Is it possible to have a fungal sinus infection & yet have a "normal or clear" CT scan? If so, what treatment(s) are recommended. Is sinus surgery worth the risk? Am I missing something unrelated to sinus like an osteoma that could be causing this neuro symptom?

[Joyce K Lee, MD]

Dear KimSb,

Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am extremely limited in not having the opportunity to perform a full neurologic examination on you, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

To begin, let me summarize your history.
It appears that you have been having symptoms of forehead tightness and pressure (described as feeling like you're wearing a helmet that's too tight) with difficulty raising your eyebrows and feelings of "being drunk" for several years.

You have seen multiple specialist and have undergone extensive testing including MRI of the Brain and C/T spine, EEG and an LP-- all of which I am assuming were normal and unrevealing.
You have also undergone a trial of multiple medications (Elavil, SSRI's, TPX and Imitrex) which INCREASED the symptoms.
You did mention being diagnosed by an allergist with ?fungal sinusitis and treated with antifungals.
ENT had originally thought that you may be a surgical candidate but since the initial visit have decided against surgery.

So, now youre question is whether your symptoms could be due to persistent sinusitis and whether a nonvisualized osteoma could also be the cause.

To begin, sinusitis is traditionally a non-neurologic medical condition. We rountinely see uncomplicated cases in our clinics, found only on CT scans for which we treat with a simple course of Amoxicillin.
The complicated sinusitis cases are seen by allergiest and ENT specialists.
From my non-expert opinion in this field, I do not think that your symptoms are completely attibutable to sinus problems.
Most people have symptoms like forehead or bilateral cheek pain and pressure, runny nose and sore throat with complicated sinusitis.  
Furthermore, it seems like you were treated with antibiotics and antifungals.
It is really not my place to comment on whether surgery would help you or not, as I do not perform these surgeries.
I recommend following-up with your ENT specialist and allergist to tease this out.
But from a neurologic perspective, it doesn't sound like the sinus headaches we typically see.

Now, your question about whether this could be an osteoma.
Interestingly, a lot of patients with craniofacial osteomas are without symptoms -- their osteomas are usually discovered incidentally on an image done for unrelated reasons.
However, with those that enlarge and lead to bone erosion which then cause headaches and facial pain.
They are fairly easy to see on plain X-rays of the skull, Ct scanning and MRI images.
The fact that you had more than one of these images without an osteoma found leads me to think that you most likely do not have a tumor.

To reassure you, I don't think that your symptoms are red flags for a severe, life-threatening disease.
I do think that you have the features of tension headaches, often described as a band-like tightness around the head.
This is a very common type of headache.

Often times, a muscle relaxant like Flexeril helps these symptoms.
Physical therapy is also helpful.

Please see a headache specialist for a formal evaluation.
With modern medicine as it is now, there is no reason for you to suffer like this.
You have tried multiple medications, but there are plenty more for you to venture.
I know that it is frustrating, but with persistence you may one day be pain-free.

Thank you,
Hope this helps,
Best wishes,
JKL, MD

[shaggy29]

Ummm, Kim, this is EXTREMELY weird.   I have had that same exact symptoms as you have (tight forehead, head pressure, hard to raise eyebrows) for 2 years now.    What is even more odd is that I DO have a frontal osteoma, and this was ignored and played off for the longest time.    Whats more is that I have a badly deviated septum like you do.   One thing I was wondering is have you had any sort of problems with vertigo?  If so, please give the details.     My plans are to have my septum fixed and a tubinectomy this fall and if that doesn't help then I'll start pushing for the osteoma removal  (big time operation)

I want to hear from you!   This is too weird

[KimSb]

Shag, no problem with vertigo, more just the tight sensation along with fuzzy/spaciness that makes me feel out really of it and makes thinking clearly difficult.

Did you ask a radiologist to look specifically for Osteomas? I'm told some read a scan and consider them normal?

I was also told that the deviated septum can create a breeding ground for bacteria & fungi in the sinuses.

[bmk]

I came across your posts while looking up my symptoms (because my doctors are no help!) and mine are really similar to both of yours.  I have a pressure in my forehead that gets worse the longer I am sitting upright or standing up.  I feel out of it all the time like I'm in a mental fog.  I've been diagnosed with vasodepressor syncope--which means that my blood pressure drops randomly and I get dizzy.  I'm on meds controlling that but it hasn't helped me feel better.  I also have a very deviated septum and am going to an ENT next week.  I have allergies too, but going to an allergist has not helped me.  The thing that helps me the most is lying down, but obviously I can't spend my whole life on the couch.  Do you two have any tricks that help you feel better?  

[KimSb]

NO, sorry nothing helps it.

[medco]

i have this sensation as well. i have epilepsy (although its no longer active) as well as a cyst in my brain