Sinus Pain or Congestion

Is this your symptom?

  • Fullness, pressure or pain on the face over a sinus
  • Sinus pain occurs above the eyebrow, behind the eye, and under the cheekbone
  • Other common symptoms can be a blocked nose, nasal discharge, or postnasal drip


  • Most often, the pain or pressure is just on one side of the face. It can be throbbing and often feels worse when bending forward.
  • Swelling around just one eye.
  • Other common symptoms are a stuffy or blocked nose or nasal discharge. You may also have a mucus drip down the back of the throat. This is called a postnasal drip.
  • Headache
  • Toothache
  • Blood in discharge from the nose
  • Less common symptoms are bad breath or mouth breathing. Also, may have a sore throat and throat clearing from postnasal drip.
  • Food may not taste as it normally does
  • Feeling of pressure in the ears
  • Cough

Causes of Sinus Congestion

Acute sinusitis. The infection comes on quickly (over a few days) and usually gets better over 2-3 weeks. It can last longer. Most cases are mild and resolve quickly. Some people get recurrent bouts of acute sinusitis. Causes are:

  • Viral Sinus Infection. Part of the common cold. A cold infects the lining of the nose. It also involves the lining of all the sinuses.
  • Bacterial Sinus Infection. A problem when the sinus becomes infected with bacteria. Occurs in 5% of colds. It starts after having a viral sinus infection. Main symptoms are increased sinus pain or return of fever. The skin around the eyelids or cheeks may become red or swollen. Thick nasal secretions that last over 14 days may point to a sinus infection.
  • Dental Infection. This can spread to the sinuses from an infected tooth. Treatment will be needed for both the dental infection and sinus infection.
  • Underlying problems that can make acute sinusitis more likely:
    • Allergic Sinus Reaction. Sinus congestion often occurs with nasal allergies (such as from pollen). Sneezing, itchy nose and clear nasal discharge point to this cause.
    • Growths (such as polyps or a tumor) can block sinus drainage and make it more likely to become infected.
    • Previous surgery or injury to the nose or face can also change the sinus so it becomes blocked more easily.
    • Underlying health problems. People with asthma, cystic fibrosis and a weakened immune system are more likely to develop acute sinusitis, as are pregnant women.
    • Smoking

Chronic Sinusitis. This is when sinusitis lasts for 12 weeks or more. You may need diagnostic tests to find out why the congestion and/or infection is not clearing.

Treatment of Sinus Congestion

  • Viral Sinus Infection. Nasal washes with saline. Antibiotics are not helpful.
  • Bacterial Sinus Infection. Antibiotics by mouth.
  • Allergic Sinus Reaction. Treatment of the nasal allergy with allergy medicines also often helps the sinus symptoms.
  • Thick Nasal Drainage. Nasal secretions need treatment with nasal saline when they block the nose. Also, treat if they make breathing through the nose hard. If breathing is noisy, it may mean the dried mucus is farther back. Nasal saline rinses can remove it.
  • Blocked Sinuses. If the sinuses are blocked due to a growth or previous surgery/injury, a surgery may be needed to open up the sinus so it will drain freely.

Color of Nasal Discharge with Colds

  • The nasal discharge changes color during different stages of a cold. This is normal.
  • It starts as a clear discharge and later becomes cloudy.
  • Sometimes it becomes yellow or green colored for a few days. This is still normal.
  • Colored discharge is common after sleep, with allergy medicines or with low humidity. Reason: all of these events decrease the amount of normal nasal secretions.

Bacterial Sinus Infections: When to Suspect

  • Yellow or green nasal discharge is seen with both viral and bacterial sinus infections. Suspect a bacterial infection if the discharge becomes thick (like pus). But, it also needs one or more of these symptoms:
  • Sinus Pain, not just normal sinus congestion. Pain occurs mainly behind the cheekbone or eye or
  • Swelling or redness of the skin over any sinus or
  • Fever lasts more than 3 days or
  • Fever returns after it's been gone for over 24 hours or
  • Nasal discharge and post-nasal drip lasts over 14 days without improvement

When to Call for Sinus Pain or Congestion

Call Doctor or Seek Care Now

  • Redness or swelling on the cheek, forehead or around the eye
  • Severe sinus pain or headache
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids, diabetes, kidney problems.
  • Fever or chills; feeling hot or shivery
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Headache lasts more than 48 hours
  • Fever lasts more than 3 days
  • Fever returns after being gone for more than 24 hours
  • Earache occurs
  • Sinus pain (not just pressure) and fever
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Sinus pain (not just pressure or fullness) lasts more than 24 hours, after using nasal washes
  • Thick yellow or green pus draining from nose and not improved by nasal washes. Exception: yellow or green tinged secretions are normal.
  • Sinus congestion and fullness lasts more than 10 days
  • Runny nose lasts more than 10 days
  • You have other questions or concerns

Self Care at Home

  • Normal sinus congestion as part of a cold

Care Advice for Sinus Congestion

  1. What You Should Know About Sinus Congestion:
    • Sinus congestion is a normal part of a cold.
    • Nasal discharge normally changes color during different stages of a cold. It starts as clear, then cloudy, turns yellow-green tinged, then dries up.
    • Yellow or green-tinged discharge. This is more common with sleep, antihistamines or low humidity. Reason: decrease the amount of normal nasal secretions.
    • Usually, nasal washes can prevent a bacterial sinus infection.
    • Antibiotics are not helpful for the sinus congestion that occurs with colds.
    • Here is some care advice that should help.
  2. Nasal Saline to Open a Blocked Nose:
    • Use a saline (salt water) nose spray. This helps to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use bottled water, distilled water or cooled, boiled tap water. Teens can just splash a little water in the nose and then blow.
    • Step 1: Put 3 drops in each nostril.
    • Step 2: Blow each nostril out while closing off the other nostril. Then, do the other side.
    • Step 3: Repeat nose drops and blowing until the discharge is clear.
    • How often: Do saline rinses when you can't breathe through the nose.
    • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
    • Reason for nose drops: blowing alone can't remove dried or sticky mucus.
    • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
  3. Fluids - Drink More:
    • Drink lots of fluids.
    • Goal: stay well-hydrated.
    • It also will thin out the mucus so it can leave the nose more easily.
    • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
  4. Humidifier:
    • If the air in your home is dry, use a humidifier. Reason: dry air makes nasal mucus thicker.
  5. Decongestant Nose Spray:
    • Use this only if the sinus still seems blocked up after nasal washes. Use the long-acting type (such as Afrin).
    • Dose: 1 spray on each side. Do this 2 times per day.
    • Always clean out the nose with saline before using.
    • Use for 1 day. After that, use only for symptoms.
    • Don't use for more than 3 days. Reason: can cause rebound congestion.
    • Decongestants (pill or capsule) are another choice. They can also open a stuffy nose and ears. Side effects: they may make a person feel nervous or dizzy. Follow the package directions.
  6. Pain Medicine:
    • To help with the pain, take an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil). Ibuprofen works well for this type of pain.
    • Use as needed, but do not take more than the maximum dosage stated on the package.
    • Try saline first. Sometimes it alone relieves the pain.
    • If you are not sure what to take, ask a pharmacist.
  7. Cold Pack for Pain:
    • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
    • Put it over the sinus for 20 minutes.
    • Caution: avoid frostbite by wrapping the ice pack in a cloth. Do not put ice directly onto the skin.
  8. Allergy Medicine:
    • If you have nasal allergies, take an allergy medicine.
    • Long-acting allergy medicines (such as Zyrtec) are a good first choice. Other options are Allegra or Claritin. Reason: these meds do not cause drowsiness.
    • Benadryl can be used if these products do not control symptoms.
    • No prescription is needed.
    • Caution: do not drive or use machinery if allergy medicines make you drowsy.
  9. Avoid Smoke and Dust:
    • Avoid smoking or working in a dusty environment
  10. What to Expect:
    • With this advice, the viral sinus blockage often goes away in 7 to 14 days.
    • The main problem is a sinus infection from bacteria. This can occur if bacteria multiply within the blocked sinus. This leads to a fever and increased pain. It needs antibiotics. Once on treatment, the symptoms will improve in a few days.
  11. Return to Work and Other Activities:
    • Sinus infections cannot be spread to others.
    • You can return to work after the fever is gone if you feel well enough to do so.
  12. Call Your Doctor If:
    • Sinus pain lasts more than 24 hours after starting treatment
    • Sinus congestion lasts more than 2 weeks
    • Fever lasts more than 3 days
    • You start to get swelling around your eye
    • You think you need to be seen
    • Your symptoms get worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023 1:00:56 AM
Last Updated: 4/13/2023 1:00:45 AM

Copyright 2023 Schmitt Decision Logic LLC.

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