Sinus Pressure: Causes and Relief

Where you feel sinus pressure

The four pairs of sinuses are air-filled spaces in the skull bones, lined with a mucus membrane that drains into the nose through small openings. When the lining swells, the openings block and pressure builds.

Pressure is often worse when bending forward, lying down or first thing in the morning, and better after blowing the nose or sitting upright.

Common causes of sinus pressure

Common cold

A cold inflames the nasal and sinus lining. Pressure peaks around days 2 to 4 and settles within 7 to 10 days. Nearly every cold involves the sinuses to some degree.

Acute sinusitis

Acute sinusitis is inflammation of the sinuses lasting up to 4 weeks. It is usually viral. A bacterial infection is more likely if:

• symptoms last more than 10 days without improving
• you have a high fever (39 °C or 102.2 °F or more) with thick discharge and facial pain for 3 to 4 days at the start
• you get better, then worse again

Allergies

Allergic rhinitis causes nasal swelling with sneezing, itchy eyes, a clear runny nose and pressure, usually in a season or around pets or dust.

Chronic sinusitis

Chronic sinusitis lasts 12 weeks or more, with blockage, thick discharge, facial pressure and reduced sense of smell. Nasal polyps, asthma and a deviated septum make it more likely.

Structural problems

A deviated septum, nasal polyps or enlarged turbinates narrow drainage pathways and cause recurring pressure, often worse on one side.

Pressure changes

Flying, diving or driving through mountains with blocked sinuses can cause sharp pressure pain (sinus barotrauma).

Irritants

Smoke, strong smells, dry air and pollution irritate the lining.

Sinus pressure without congestion

If you have facial pressure but a clear nose, consider other causes:

• Migraine: studies show most self-diagnosed "sinus headaches" are migraines. Migraine can cause facial pressure and even a runny nose and watery eyes, but it also brings throbbing pain, nausea, sensitivity to light, and attacks that last 4 to 72 hours and recur.
• Tension headache: a band-like pressure around the forehead.
• Dental problems: an upper tooth infection can mimic cheek pressure.
• Temporomandibular joint disorder: aching in front of the ear and cheek, worse with chewing.
• Cluster headache: severe pain behind one eye with a watery eye and blocked nostril on the same side.
• Trigeminal neuralgia: brief electric shock pains in the face.

How doctors find the cause

Diagnosis is usually based on symptoms and a look in the nose. Imaging is not needed for routine acute sinusitis. Tests are used for chronic, recurrent or complicated cases:

• nasal endoscopy: a thin camera to look at drainage openings and polyps
• CT scan of the sinuses for chronic sinusitis, before surgery, or if complications are suspected
• allergy testing for recurring seasonal symptoms

How to relieve sinus pressure

At home

• Saline rinses or sprays: a squeeze bottle or neti pot with saline flushes out mucus. Use distilled, sterile or previously boiled water, never straight tap water.
• Steam: breathe steam from a shower or a bowl of hot water. Keep hot water away from children.
• Warm compresses over the cheeks and forehead.
• Rest with your head raised to help drainage.
• Stay hydrated to thin mucus.
• Humidify dry indoor air.

Over-the-counter medicines

• Pain relievers: acetaminophen (paracetamol) or ibuprofen. Follow the label dose. No aspirin for children or teenagers.
• Decongestant nasal sprays (oxymetazoline): fast relief, but use for no more than 3 days to avoid rebound congestion.
• Oral decongestants (pseudoephedrine): may help adults. Avoid with high blood pressure, heart disease, glaucoma or an enlarged prostate.
• Steroid nasal sprays (fluticasone, budesonide, mometasone): reduce swelling over several days. Best for allergies, chronic sinusitis and sinusitis lasting more than 10 days.
• Antihistamines help when allergies are the cause.

Medical treatment

• Antibiotics only for likely bacterial sinusitis (see the criteria above). Most acute sinusitis clears without them.
• Allergy treatment, including immunotherapy.
• Surgery (functional endoscopic sinus surgery or septoplasty) for chronic sinusitis, polyps or a deviated septum that do not respond to medicines.
• Migraine treatment if migraine is the true cause.

Preventing sinus pressure

• Use saline rinses regularly if you get recurrent sinus problems.
• Control allergies during your trigger season.
• Avoid smoke and stop smoking.
• Wash hands to reduce colds.
• Use a decongestant spray before flying if you have a cold, if your doctor agrees.

Frequently asked questions

How do I relieve sinus pressure fast?

Saline rinses, steam, warm compresses, and sleeping with your head raised give quick relief. A decongestant nasal spray works within minutes but should be used no more than 3 days. Pain relievers ease the ache. A steroid nasal spray helps over several days.

What causes sinus pressure behind the eyes?

Pressure behind the eyes usually comes from the ethmoid or sphenoid sinuses during a cold, allergies or sinusitis. Migraine and cluster headaches can feel similar. Swelling around the eye, double vision or vision loss with sinus symptoms is an emergency.

Can sinus pressure make your head feel full or dizzy?

Yes. Swollen sinuses and blocked Eustachian tubes can cause head fullness, ear pressure and mild light-headedness or imbalance. True spinning vertigo, severe headache or vision changes point to other causes and need a doctor's assessment.

How long does sinus pressure last?

With a cold, sinus pressure usually eases within 7 to 10 days. Acute sinusitis can last up to 4 weeks. Pressure lasting more than 12 weeks is chronic sinusitis. See a doctor if pressure lasts beyond 10 days without improvement.

Is my sinus headache actually a migraine?

Often, yes. If you have recurring facial pressure without thick discharge or fever, along with throbbing pain, nausea or sensitivity to light, it is more likely migraine. Migraine treatments work far better than sinus medicines for these headaches.