Can idiopathic intracranial hypertension (IIH) cause intermittent ear pressure, facial pressure, and pain that migrates around the nose, eyes, cheekbones, jaw, and head?

Can IIH Cause Your Symptoms?

Yes, idiopathic intracranial hypertension (IIH) can absolutely cause the intermittent ear pressure, facial pressure, and migrating pain you describe around your nose, eyes, cheekbones, jaw, and head—these symptoms are well-documented in IIH and often mimic sinus disease.

Why Your Symptoms Fit IIH

Your symptom pattern is highly characteristic of IIH for several reasons:

• Ear pressure requiring constant "popping" is a classic IIH symptom, reported as pulsatile tinnitus or intracranial noises in 58% of IIH patients 1
• Facial pressure and pain around the nose, eyes, and cheeks frequently mimics sinus disease in IIH patients 2
• The migrating, intermittent nature of your pain is typical—IIH headaches are highly variable in location and intensity 2
• Pressure extending to teeth and jaw is consistent with trigeminal nerve involvement from elevated intracranial pressure 2

The Sinus Mimicry Problem

"Sinus headache" is one of the most common misdiagnoses in patients who actually have IIH or migraine with cranial autonomic symptoms 2. Here's why you've been confused:

• Approximately 62% of pediatric migraineurs (and IIH often has migrainous features) have cranial autonomic symptoms like rhinorrhea and facial pressure from trigeminal-autonomic reflex activation 2
• The pressure in your nose and facial bones is likely from increased intracranial pressure affecting the trigeminal nerve distribution, not actual sinus inflammation 2
• 68% of IIH patients have a migrainous headache phenotype, which commonly includes facial pressure and nasal symptoms 3, 4

Key Distinguishing Features of IIH

You should be evaluated for IIH if you have:

• Headache that is progressively more severe and frequent 2
• Transient visual obscurations (brief episodes of vision darkening, lasting seconds)—reported in 68% of IIH patients 1
• Pulsatile tinnitus (whooshing sound in ears) 2, 5
• Horizontal diplopia (double vision) 2
• Headache worsening with Valsalva, cough, or lying flat 4

Critical Next Steps

You need an ophthalmologic examination to check for papilledema (optic disc swelling), which is present in most but not all IIH cases 2, 5:

• Papilledema is the most specific sign of IIH, but more than 5% of IIH patients do not have papilledema 5, 6
• Even without papilledema, you can still have IIH (called "IIH without papilledema") 6
• Visual field testing is essential to detect any vision loss 2, 7

If papilledema or visual field defects are found, you need urgent evaluation to prevent permanent vision loss 7, 3.

Diagnostic Workup Required

The definitive diagnosis requires:

• MRI brain with venography to exclude structural causes and venous sinus thrombosis 2, 8
• Lumbar puncture with opening pressure measurement—IIH is defined by pressure >250 mm CSF with normal CSF constituents 2, 8
• Opening pressure between 200-250 mm CSF is in a gray zone and requires clinical correlation 2

Important Caveats

Do not assume this is just sinus disease without proper IIH evaluation, especially if:

• You are an overweight woman of childbearing age (the typical IIH demographic) 2, 1
• You've had recent weight gain 1
• Standard sinus treatments haven't helped 2
• Your symptoms occur daily 1

The intermittent nature of your pain does not exclude IIH—IIH symptoms characteristically fluctuate and are not constant 2, 5. The fact that "sometimes it's there, sometimes it's not" is entirely consistent with IIH.

Why This Matters

Untreated IIH can cause permanent vision loss 7, 5. While your symptoms may seem primarily bothersome rather than dangerous, the underlying condition requires evaluation because:

• Visual loss can occur even in patients who are asymptomatic from a headache standpoint 3
• Treatment failure with worsening vision occurs in 34% at 1 year and 45% at 3 years if not properly managed 7, 3

You need to see a neurologist or neuro-ophthalmologist who can perform the appropriate evaluation, including fundoscopic examination, visual field testing, and consideration of lumbar puncture if imaging and eye exam suggest IIH 2, 7.