Read about the wider assessment and treatment approach for persistent post-concussion symptoms.
A blocked nose, facial pressure or a feeling that the nasal passages have become narrower may not be the first symptoms people associate with a concussion or head injury.
But for some people, the change is very noticeable.
They may describe:
- one side of the nose feeling more restricted than before
- difficulty breathing freely through the nose
- increased mouth breathing
- pressure through the bridge of the nose
- pressure beneath or around the eyes
- cheek or facial pressure
- a feeling of congestion despite having little mucus
- nasal sprays providing only temporary or limited relief
- their nose or face simply feeling physically “different” since the injury
There are many possible causes of nasal congestion and sinus pressure, including inflammation, allergy, infection and pre-existing structural problems.
But when symptoms begin or noticeably change following a blow to the head or face, we also consider another possibility:
Has the trauma changed — or re-aggravated — the mechanics of the nasal and craniofacial structures themselves?
Head Trauma Doesn't Only Affect the Brain
A concussion is usually discussed in terms of what happens to the brain.
But the force responsible for the concussion also passes through the physical structures surrounding it.
Depending on the direction of impact, forces may be transmitted through the:
- forehead
- nose
- cheekbones
- upper jaw
- palate
- temporal regions
- cranial base
- upper cervical spine
The facial skeleton is an interconnected structural system.
The bones forming the nasal passages and surrounding facial structures include the vomer, ethmoid, sphenoid, maxillae, palatine and zygomatic bones.
These structures do not exist independently of one another.
A change in one part of the system can influence the mechanical relationships elsewhere.
The Current Injury May Not Be the First Injury
It is also important not to look at the most recent injury in isolation.
Many patients have a history of previous concussions, sporting impacts, falls, whiplash injuries or direct trauma to the face and head. Sometimes there have been several injuries over many years.
Symptoms from an earlier injury may have settled without the underlying cranial and craniofacial mechanics fully returning to normal.
In these cases, the patient may already have areas of restriction or asymmetry involving the nasal structures, facial bones, cranial base, temporal regions, occiput or upper cervical spine before the latest injury occurs.
The new injury is then occurring against a background of pre-existing altered mechanics.
Sometimes it creates an entirely new restriction. But in other cases it may re-aggravate an older mechanical pattern that had never completely resolved.
This can help explain why the apparent severity of the latest injury does not always correspond with the severity or persistence of the symptoms that follow.
A relatively modest impact may produce significant symptoms in someone whose cranial and craniofacial system was already mechanically compromised by previous trauma.
This is why our assessment is not limited to:
“What happened in this concussion?”
We also want to know:
“What injuries occurred before this one, how completely did you recover, and what mechanical restrictions may already have been present when the latest injury occurred?”
For Cranial Solutions, the history of previous trauma is therefore an important part of understanding the patient's current cranial, facial and nasal mechanics.
The Vomer: A Small Bone in an Important Position
The vomer is particularly interesting when considering nasal symptoms following head trauma.
It forms an important part of the nasal septum and extends backwards and upwards toward the sphenoid.
Its position means it participates in the structural relationship between the nasal septum, palate and deeper cranial base.
The vomer-sphenoid relationship is one of the areas we consider when assessing the effects of trauma through the nasal and craniofacial system.
Rather than assuming every post-traumatic blocked nose is caused by swollen nasal tissue, we consider whether the internal nasal and facial structures themselves may also be restricted.
The Ethmoid, Sphenoid and Deeper Nasal Structures
The vomer is only part of the picture.
The ethmoid forms a major part of the upper nasal cavity and contributes to the nasal septum and medial walls of the orbits.
The sphenoid sits deeper within the cranial base and has extensive relationships with the nasal cavity, orbits, facial skeleton and wider cranium.
The palatine and maxillary bones contribute to the nasal cavity, palate and surrounding facial architecture.
The zygomatic bones form the prominent cheek region and participate in the wider mechanical behaviour of the face.
This means that a structural change following trauma does not necessarily remain isolated to the exact point where the person was hit.
The nasal airway sits within an interconnected craniofacial framework.
That is the framework we assess with NasalRx.
Why Can a Nose Feel Blocked Without Much Mucus?
The sensation of nasal obstruction does not always mean the nose is full of mucus.
Airflow through the nose depends on both the nasal lining and the physical dimensions and geometry of the airway.
If one nasal passage is mechanically narrower, airflow resistance can increase and breathing through that side may feel considerably more difficult.
This is why someone can genuinely feel obstructed even when they are not experiencing the discharge normally associated with a cold or acute sinus infection.
Following head or facial trauma, we are particularly interested when the patient says:
“Ever since the injury, I just can't breathe through my nose the way I could before.”
That history makes the structural component worth assessing.
Why Can Facial or Sinus Pressure Develop After a Head Injury?
Facial and sinus pressure can develop alongside changes in nasal and craniofacial mechanics following head or facial trauma.
The nasal cavity and surrounding sinus regions sit within an interconnected framework formed by the vomer, ethmoid, sphenoid, maxillae, palatine and zygomatic bones.
If trauma leaves restriction or altered movement within this system, patients may experience pressure through areas such as:
- the bridge of the nose
- beneath or around the eyes
- the cheeks and maxillary region
- the forehead
- the deeper nasal passages
- one side of the face more than the other
This may occur together with reduced nasal airflow, a feeling of internal compression or congestion, facial tension, headache or head pressure.
At Cranial Solutions, we are particularly interested when these symptoms began after the injury or changed noticeably following it.
They may also represent the return or worsening of symptoms associated with an older injury.
In either situation, we assess whether restriction within the nasal and craniofacial structures may be contributing to the patient's symptoms.
This is also where NasalRx can be particularly useful. By applying controlled internal pressure through the nasal passages, we can mechanically influence structures and articulations within this region that cannot be approached in the same way externally.
When these restrictions change, patients often report corresponding changes in nasal airflow, facial pressure, sinus-pressure sensations and the overall feeling of restriction through the face and head.
This does not mean that every case of sinus pressure is mechanical. Infection, allergy, inflammation and other sinus or ENT conditions remain important considerations where the history and symptoms indicate them.
Nasal Restriction and Mouth Breathing
Persistent difficulty breathing through the nose can have consequences beyond the nose itself.
If nasal airflow becomes difficult, people naturally compensate by opening the mouth.
For some people this becomes their habitual breathing pattern.
That matters because nasal and mouth breathing are not mechanically identical.
Breathing pattern can influence:
- tongue position
- jaw position
- head and neck posture
- upper airway mechanics
- diaphragmatic recruitment
- rib-cage and thoracic movement
- sleep and perceived breathing comfort
This is one reason improved nasal breathing is clinically important to us rather than simply being a pleasant side effect of treatment.
Why NasalRx Is Different
NasalRx approaches the problem from inside the nasal passages.
Brief, controlled pressure is applied internally, allowing us to mechanically influence areas of the nasal and craniofacial system that cannot be approached in the same way externally.
Depending on the pattern of restriction, treatment may influence relationships involving the:
- vomer
- ethmoid
- sphenoid
- maxillae
- palatine bones
- zygomatic region
- temporal bones
- wider cranial base
This is an important point about NasalRx.
The treatment is structural and mechanical.
It is not simply an attempt to relax the patient or create a subtle energetic change.
We identify restriction, introduce a controlled physical force and assess how the surrounding structures respond.
Are the Changes Always Subtle?
No.
Some changes are relatively subtle.
Others can be considerably more obvious.
With certain restrictions, there may be a palpable structural release during treatment. There can also sometimes be an audible cavitation or release associated with the correction.
Afterwards, we may find a noticeable change in the movement and symmetry of the surrounding nasal and facial structures.
Most importantly from the patient's perspective, one of the most consistent changes we see following NasalRx is improved nasal airflow.
Some people notice this immediately.
They may describe:
- being able to breathe through a previously restricted side
- the nasal passages feeling wider or more open
- less effort required to breathe through the nose
- reduced facial or sinus pressure
- less need to breathe through the mouth
- the face feeling less compressed or restricted
The degree of change varies from person to person.
Nasal Breathing May Matter Beyond the Nose
Improving nasal airflow may have implications beyond simply making breathing more comfortable.
Respiration produces rhythmic pressure changes throughout the chest and venous system.
These pressure changes extend into the spinal and cranial compartments and are recognised contributors to cerebrospinal fluid movement.
This does not mean that opening a nasal passage automatically increases CSF flow or glymphatic clearance.
But it does create an interesting physiological relationship.
If NasalRx substantially improves someone's ability to breathe through their nose, and that allows a more effective respiratory pattern with better diaphragmatic and thoracic mechanics, it may change the respiratory pressure environment that contributes to normal venous and CSF dynamics.
This is particularly interesting in people who have both persistent post-concussion symptoms and significant nasal restriction.
NasalRx and the Wider Cranial System
The internal nasal structures are also mechanically connected with the wider craniofacial and cranial system.
This is why we don't necessarily treat a restricted nasal passage as an isolated airway problem.
Following NasalRx, we often observe changes extending beyond the nose into the wider cranial and facial mechanics.
Depending on the individual, this can include changes involving the sphenoid, facial structures, temporal regions, occiput and cranial base.
Patients may simultaneously report changes in:
- nasal breathing
- facial or sinus pressure
- head pressure
- headache
- cranial or facial tension
- posterior scalp tension
- mental clarity
- light sensitivity
- discomfort with directional eye movement
The fact that several changes can occur together is one reason we view the nasal passages as an important internal access point into the wider craniofacial system.
Is Every Blocked Nose After a Head Injury a Cranial Restriction?
No.
Nasal congestion has many possible causes.
These include:
- allergy
- viral illness
- sinus inflammation or infection
- enlarged turbinates
- septal deviation
- nasal polyps
- previous nasal trauma
- other ENT conditions
The timing and pattern matter.
We become particularly interested in a structural component when nasal breathing changed following the injury, especially when there are accompanying cranial, facial, jaw, cervical or post-concussion symptoms.
We are also interested when a new injury has re-aggravated symptoms associated with previous head, facial or cervical trauma.
Where symptoms suggest an ENT or medical problem, appropriate assessment or referral remains important.
What We Assess
When nasal symptoms have developed or worsened following head or facial trauma, we may assess:
- previous concussions, head or facial injuries and the degree of recovery
- whether the latest injury appears to have re-aggravated an older symptom pattern
- nasal airflow from side to side
- internal nasal restriction
- facial symmetry and movement
- vomer and deeper nasal relationships
- maxillary and palatal mechanics
- zygomatic and facial movement
- sphenoid and cranial-base mechanics
- jaw/TMJ where relevant
- cervical and upper cervical mechanics
- associated headache, head pressure or facial pressure
- mouth-breathing tendency
The aim is not simply to decide whether somebody has a “blocked nose.”
The question is:
Has this injury — or the accumulated effect of previous injuries — left a mechanical restriction within the nasal and craniofacial system that may still be affecting the way you breathe and the way your face and head feel?
Frequently Asked Questions
Why has my nose felt blocked since my concussion?
There are several possible explanations. Inflammation, allergy and pre-existing nasal problems should be considered.
But head and facial trauma can also expose the nasal and craniofacial structures to substantial mechanical forces.
If your nasal breathing noticeably changed after the injury, assessing the structural mechanics of the nasal and facial region may be worthwhile.
Could an older concussion or head injury still be relevant?
Yes.
The most recent concussion is not always the beginning of the mechanical problem.
Some patients have experienced previous concussions, whiplash injuries, sporting impacts, falls or facial trauma without complete recovery of their cranial and craniofacial mechanics.
A later injury may then create additional restriction or re-aggravate an existing mechanical pattern.
This is why previous injury history and the quality of recovery from those injuries are important parts of our assessment.
Can my nose feel blocked even if I don't have much mucus?
Yes.
The sensation of nasal obstruction can result from the physical dimensions and resistance of the nasal airway as well as swelling or mucus.
This is why some people can feel persistently blocked despite having relatively clear nasal passages.
Why haven't nasal sprays fixed it?
Nasal sprays can be useful when inflammation or allergy is contributing to nasal obstruction.
But they do not address every possible structural component of the nasal airway.
If symptoms began following trauma and there is significant mechanical restriction, the structural component may also need to be considered.
What structures does NasalRx work with?
NasalRx uses controlled internal pressure within the nasal passages.
Depending on the individual's restriction, we may observe mechanical changes involving the vomer, ethmoid, sphenoid, maxillary, palatal and zygomatic regions, with effects extending into the wider cranial system.
Can NasalRx improve nasal breathing?
Improved nasal airflow is one of the most consistent changes we observe clinically following NasalRx.
The amount of improvement varies between patients and depends on the causes of their nasal restriction.
Does better nasal breathing improve CSF flow?
Respiration is a recognised contributor to craniospinal CSF movement.
It is therefore reasonable to be interested in whether substantial improvements in nasal breathing and respiratory mechanics could influence this system.
However, we do not currently have direct physiological measurements demonstrating that NasalRx increases CSF flow or glymphatic clearance.
Is NasalRx only for people who have had a concussion?
No.
Nasal and craniofacial restriction can occur in people without concussion.
However, this article focuses specifically on people who noticed nasal obstruction, facial pressure or altered breathing following a head or facial injury — including people in whom a new injury may have re-aggravated the effects of previous trauma.
Could Your Nasal Symptoms Have a Structural Component?
If your nose has felt blocked, restricted or physically different since a concussion or head injury — particularly if you also experience facial or sinus pressure, head pressure, headache, facial tension or other persistent post-concussion symptoms — a structural assessment may help determine whether the nasal and craniofacial mechanics are part of the picture.
The same applies when the latest injury appears to have brought back or intensified symptoms following previous head or facial trauma.