IIH Does Not Typically Present with Nasal, Dental, or Facial Pressure
The pressure sensations you describe in the nose, septum, front teeth, and facial regions are not characteristic presentations of Idiopathic Intracranial Hypertension and should prompt evaluation for alternative diagnoses such as sinus disease, trigeminal neuralgia, or temporomandibular joint disorders.
Recognized Symptoms of IIH
The established symptom profile of IIH is well-defined in consensus guidelines and does not include nasal or dental pressure:
Primary symptoms include:
- Progressively severe and frequent headache (most common presenting symptom) 1, 2
- Transient visual obscurations (unilateral or bilateral darkening of vision lasting seconds) 1, 2
- Pulsatile tinnitus (whooshing sound synchronous with pulse) 1, 2
- Visual blurring 1, 2
- Horizontal diplopia (typically from sixth nerve palsy) 1, 2
Additional recognized symptoms include:
Critical Absence of Facial/Nasal Symptoms
None of the consensus guidelines or symptom frequency data mention pressure in the nose, septum, teeth, or facial regions as manifestations of IIH 1, 2. The 2018 consensus guidelines from the Journal of Neurology, Neurosurgery and Psychiatry specifically enumerate IIH symptoms and explicitly state that "none of which are pathognomonic for IIH," but nasal, dental, or specific facial pressure patterns are notably absent from this comprehensive list 1.
Why This Matters Clinically
The headache phenotype in IIH is highly variable and may mimic other primary headache disorders 1, 2, which can create diagnostic confusion. However, the specific distribution you describe—involving the nasal septum, front teeth, inner corners behind the eyes, outer cheeks, and jaw—suggests:
- Trigeminal nerve distribution pain (V1, V2, V3 branches)
- Sinus pathology (maxillary or ethmoid sinusitis)
- Temporomandibular joint dysfunction
- Dental pathology
These conditions require entirely different diagnostic workup and management than IIH.
Common Pitfall to Avoid
Do not attribute all head and facial pressure symptoms to IIH simply because a patient has been diagnosed with this condition. The pressure pattern you describe follows anatomical distributions that are not explained by generalized intracranial hypertension. While IIH patients may have coexisting conditions, the specific nasal-dental-facial pressure pattern warrants evaluation by otolaryngology, dentistry, or orofacial pain specialists 3.
When IIH Does Present to ENT
Otolaryngologists may encounter IIH patients, but typically for different reasons:
- CSF rhinorrhea or otorrhea (from elevated pressure causing CSF leaks) 3
- Hearing loss or balance disturbance 3
- Tinnitus (pulsatile type specifically) 3
These are distinct from the pressure sensations in the nose and teeth that you describe 3.