Painful Sinuses: Causes and Relief

Where sinus pain is felt

The sinuses are air-filled spaces in the bones of the face, lined with mucus-producing tissue that drains into the nose through small openings. When the lining swells, mucus is trapped and pressure builds.

Sinus pain typically feels like pressure or a dull ache that is worse when bending forward, lying down or with sudden head movement, and is often worse in the morning.

Causes of painful sinuses

Colds and acute sinusitis

Nearly every cold inflames the sinuses. Acute sinusitis means symptoms last up to 4 weeks: nasal congestion, thick discolored discharge, facial pain or pressure and reduced smell. Over 90% of cases are viral. Bacterial sinusitis is suspected when:

• symptoms persist for more than 10 days without improving
• symptoms are severe from the start, with fever of 39 °C (102.2 °F) or higher and facial pain for 3 to 4 days
• symptoms improve, then worsen again

Chronic sinusitis

Chronic sinusitis lasts 12 weeks or more, with blockage, discharge, reduced smell and facial pressure. Pain is often milder. Nasal polyps, allergies, asthma and a deviated septum contribute.

Allergies

Hay fever swells the nasal lining and can block sinus drainage, causing pressure along with sneezing, itching and clear discharge.

Barotrauma

Pressure changes when flying or diving can cause sudden sharp sinus pain, especially with a cold.

Dental infection

An infected upper back tooth can spread infection into the maxillary sinus, causing one-sided sinusitis with a foul smell. Conversely, sinusitis often causes aching in several upper teeth. See dental abscess.

Conditions that feel like sinus pain

Most people who think they have recurring "sinus headaches" actually have migraine. Migraine can cause facial pressure, a runny nose and watery eyes through the nerves it activates. Clues:

Other mimics include tension headache, cluster headache (severe pain around one eye with tearing and a runny nostril on the same side), jaw joint (TMJ) problems, and trigeminal neuralgia (brief electric-shock facial pain).

How doctors diagnose it

Sinusitis is diagnosed from symptoms and examination of the nose and face. X-rays are not useful. A CT scan is reserved for chronic or complicated sinusitis or before surgery. An ENT specialist may look inside the nose with a thin endoscope to check for polyps, pus or structural problems. Allergy testing helps when allergy is suspected.

Sinus pain relief

At home

• Saline rinses or sprays: rinse the nose once or twice daily with a squeeze bottle or neti pot. Use distilled, sterile or previously boiled and cooled water only, never straight from the tap.
• Pain relievers: acetaminophen (paracetamol) or ibuprofen. Follow the label dose.
• Warm compresses over the face for a few minutes several times a day.
• Steam: breathing warm, moist air from a shower can loosen mucus.
• Rest, fluids, and sleeping with your head raised.

Medicines

• Steroid nasal sprays (fluticasone, mometasone, budesonide) reduce swelling. They take a few days to work and help both acute and chronic sinusitis.
• Decongestant nasal sprays (oxymetazoline) for no more than 3 days, to avoid rebound congestion.
• Oral decongestants may help some adults. Avoid if you have high blood pressure, heart disease, glaucoma or prostate enlargement.
• Antihistamines help only if allergies are involved.
• Antibiotics are prescribed only when bacterial sinusitis is likely. Many doctors recommend waiting 7 days with good symptom care first in mild cases, because most improve without them.

For chronic problems

Long-term steroid sprays and rinses, treating allergies, and in some cases endoscopic sinus surgery to open drainage pathways or remove polyps. Biologic drugs help some people with severe nasal polyps.

Frequently asked questions

How do I relieve sinus pain fast?

Combine a pain reliever such as acetaminophen or ibuprofen with a saline rinse, a warm compress and steam. A decongestant spray can quickly open the nose, but use it for no more than 3 days. A steroid nasal spray helps over several days.

How do I know if my sinus pain is an infection?

Most sinus pain during a cold is viral. A bacterial infection is more likely if symptoms last over 10 days without improving, start severely with high fever and facial pain, or improve and then worsen again. A doctor can decide whether antibiotics are needed.

Can sinus pain cause toothache?

Yes. The roots of the upper back teeth sit right below the maxillary sinuses, so sinusitis often causes aching in several upper teeth, worse when bending or walking. Pain in a single tooth, sensitivity to hot or cold, or a swollen gum points more to a dental problem.

Why are my sinuses painful without a cold?

Facial pressure without a blocked nose or discharge is often migraine or tension headache rather than sinus disease. Allergies, dental problems, jaw joint issues and pressure changes when flying are other causes. See a doctor if it keeps coming back.

How long does sinus pain last?

With a cold or viral sinusitis, sinus pain usually peaks in the first few days and improves within 7 to 10 days. Bacterial sinusitis may take 2 to 3 weeks to settle. Pain lasting more than 12 weeks suggests chronic sinusitis.