Stabbing Headache Around Eye or Cheek

Do you suffer from a stabbing headache in the areas denoted in red? Do these headaches seemingly come out of nowhere one day? Perhaps started after a viral upper respiratory infection?

You may be suffering from a condition known as contact point headache. This type of headache is also known as:

• Sluder's neuralgia
• Anterior ethmoid neuralgia
• Sphenopalatine ganglion neuralgia
• Pterygopalatine ganglion neuralgia

This type of headache has often been confused with cluster headache, migraine without aura, sinusitis, or other undefinable pathology especially since CT scans and MRI scans that are obtained often do not reveal any tumor or presence of infection.

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Why Does the Nose Whistle in Some People?

Though most people like the professional nose whistler shown here require an instrument to enable the nose to whistle, in others it occurs naturally due to unique anatomic features within the nose.

Why might someone's nose whistle?

Septal Perforation

The most common reason it may occur constantly is due to a hole in the septum (septal perforation). The septum is a wall that divides the right nasal cavity from the left side. Normally, it should be straight and without any openings.

However, when a hole is present in the septum and it is in just the right size and place, whenever air is breathed in and out the nose, it will whistle. In this situation, the hole is the "window" of the whistle and the nose itself is the mouthpiece.

Correction of this problem is by either closing the hole (septal button or surgery) or making it bigger such that the aerodynamics eliminate the conditions conducive to nasal whistling. As an FYI, surgical correction of a septal perforation is quite difficult.

Septal Deviation and Some Nasal Congestion

The other situation when the nose may whistle, but only intermittently, is when there is a deviated septum. In this scenario, the septum rather than being straight, it is slightly crooked to one side making one side more narrow than the other.

Add some slight swelling of the nasal lining such that the opening of the nose is restricted to just right size and shape, and it may whistle.

This type of nasal whistling is akin to grass whistling (blowing between two thumbs holding a blade of grass).

Thankfully, the nasal conditions that lead to nasal whistling is quite rare and requires the perfect storm of just the right amount of septal deviation with just the right amount of nasal congestion.

As such, correction of this problem is fairly easy as one needs to change either the congestion causing the nasal lining to swell with a nasal spray or anti-histamine OR fix the deviated septum. If the inferior turbinates are enlarged, they can be reduced in size as well.

Of course, one can take this unusual condition and make it a positive feature worthy of a concert hall... WITHOUT the assistance of any instrument!

Can a Deviated Septum Cause Facial Pain?

Yes...

There is a phenomenon caused Sluder's Neuralgia whereby a patient may suffer fairly severe pain over the cheek and around the eye due to a severe deviated septum... not just any deviated septum, but a sub-type called a septal spur.

As an introduction, a nasal septum is a wall that divides the nasal cavity down the middle. This nasal wall is much larger than people realize... perhaps a little bigger than a large man's watch.

In some individuals, the septum (purple arrow) may be deviated to one side causing narrowing resulting in symptoms of nasal obstruction.

In a further subset of individuals, the septum may be even more deviated with a "spur" digging into the side of the nasal cavity as shown by the black arrowhead below.

In this scenario, the patient will feel pain in the cheek and eye region on the same side as the septal spur. If nasal swelling occurs, the pain will become more severe. Such swelling may occur from allergies or a viral infection. As such, the pain fluctuates depending on how much mucosal swelling is present.

This situation is analogous to a bunion on the foot. Just like the septal spur, if the bunion digs too hard into a shoe, a person may feel foot pain. If the foot swells due to standing or edema, the pain may become more severe.

Shown below is a septal spur before and after mucosal lining swelling has occurred.

Treatment is a surgical procedure called septoplasty which basically removes the spur and straightens the septum back to the midline.

Read more about the procedure here.

Read more about this type of headache here.