Sinus Pain and Congestion

Definition

  • Feeling of fullness, pressure, and pain on the face over a sinus cavity. These are found above the eyebrow and behind or around the eye. They are also found over the cheekbone.
  • Pain or pressure may be on both sides of the face. More often, the pain is on one side of the face.
  • Other problems include a blocked nose, runny nose, and postnasal drip.

Some Basics...

  • The sinuses are spaces of air between the bones around the nose. They make mucus that drains into the nose.
  • Sinus pain and congestion are caused by blocked sinuses. This can result from infection or nasal allergies. 
  • Sinus pain and congestion are normal parts of a cold.

Causes

Sinus pain happens when one or more sinuses become blocked by an infection or nasal allergy.

  • Allergic Sinusitis (Hay Fever): When an allergen bothers the nose, it may cause a stuffy nose. This is due to swelling of the sinus passages. Other symptoms include sneezing, itchy and clear runny nose, and itchy watery eyes.
  • Viral Sinusitis: This type of sinusitis is caused by a virus. These include rhinosinusitis and a cold. The infection of the nose lining can spread to the lining of the sinuses. Antibiotics do not help this type of sinusitis get better.
  • Bacterial Sinusitis: This type of sinusitis is caused by bacteria. It can develop after viral sinusitis. One or more sinuses with the virus may then become infected with bacteria. Sinus symptoms that last more than 10 days suggests that bacterial sinusitis is present. Sinus pain can get worse and fevers may return. Antibiotic treatment is usually needed.
  • Rhinitis Medicamentosa: This is caused by using decongestant nose drops for more than 5 days. This can cause the nose to become even stuffier.

Treatment

Treatment depends on the cause.

  • Allergic (Hay Fever): Antihistamines can help. These include diphenhydramine (Benadryl), loratadine (Claritin, Alavert), fexofenadine (Allegra), or cetirizine (Zyrtec). Nasal corticosteroid sprays work very well to treat hay fever. Nasal washes are also helpful.
  • Viral: Use nasal washes. Antibiotics are not helpful.
  • Bacterial: Use nasal washes. Antibiotics may be needed.

When to Call Us for Sinus Pain and Congestion

Call Us Now (night or day) If

  • You feel weak or very sick
  • Trouble breathing, and it is not from a blocked or stuffy nose
  • Severe pain
  • Fever of 103°F (39.4°C) or higher
  • Fever of 100.5°F (38.1°C) or higher and over 60 years old
  • Fever and have diabetes
  • Fever and have a weak immune system from:
    • HIV positive
    • Cancer chemo
    • Long-term steroid use
    • Splenectomy
  • Fever and are bedridden (nursing home patient, stroke, chronic illness, or recovering from surgery)
  • Redness or swelling on the cheek, forehead, or near the eye

Call Us During Weekday Office Hours If

  • You have other questions or concerns
  • Sinus pain (not just pressure) after using nasal washes for 24 hours
  • Sinus congestion (pressure) lasts more than 10 days
  • Runny nose lasts more than 10 days

Parent Care at Home If

  • Sinus congestion as part of a cold

CARE ADVICE

Care Advice for Mild Sinus Pain and Congestion

What You Should Know:
  • Sinus pain and congestion are normal parts of a cold.
  • Most often, nasal washes can stop you from getting a bacterial sinus infection. Antibiotics are not helpful.
  • You can treat mild sinus pain and congestion at home.
  • Here is some care advice that should help.
For a Runny Nose: Blow the Nose.
  • Runny noses help to wash viruses and bacteria out of the nose.
  • Blowing the nose is all that is needed.
  • The skin near your nostrils may get irritated. You can rub a tiny amount of petroleum ointment on it 1-2 times a day.
For a Stuffy Nose - Use Nasal Washes:
  • Salt water washes are a good way to treat sinus pain. You can pour, spray, or squirt water into your nose. Then let the water run back out.
  • How It Helps: The salt water rinses out mucus, dust, and allergens. It also keeps the nose moist.
  • Methods: There are a few ways to do nasal washes. You can use a:
    • Nasal spray bottle (sold over-the-counter)
    • Rubber ear syringe
    • Medical syringe without the needle
    • Neti Pot
Step-By-Step Instructions:
  • Step 1: Lean over a sink.
  • Step 2: Gently squirt or spray warm salt water into one of your nostrils.
  • Step 3: Some of the water may run into the back of your throat. Spit this out. If you swallow the salt water, it will not hurt you.
  • Step 4: Blow your nose to clean out the water and mucus.
  • Step 5: Repeat steps 1-4 for the other nostril. Do this a couple times a day if it helps you.
How to Make Salt Water Nasal Wash:
  • You can make your own salt water nasal wash.
  • Add 1/2 tsp of table salt to 1 cup (8 oz.; 240 ml) of warm water.
Hydration: Drink plenty of liquids (6-8 glasses of water a day). If the air in your home is dry, use a cool mist humidifier.
Cold Medicines: Most of these drugs are not helpful. They cannot remove dried mucus from the nose. Antihistamines are only helpful if you also have nasal allergies. Antibiotics are not helpful unless you have an ear or sinus infection.
Nasal Decongestants for a Very Stuffy Nose:
  • Nasal decongestants can help you breathe better. They also help with nasal drainage. They may be taken as pills by mouth or as a nose spray.
  • Most people do NOT need to use these drugs.
  • Pseudoephedrine (Sudafed): This is sold over-the-counter (OTC) in pill form. Normal adult dose is two 30 mg tablets every 6 hours.
  • Phenylephrine (Sudafed PE): This is sold OTC in pill form. Normal adult dose is two 30 mg tablets every 6 hours.
  • Oxymetazoline Nose Drops (Afrin): These are sold OTC. Blow your nose to clean out the mucus before using. Spray each nostril once. Wait one minute and then spray a second time.
  • Phenylephrine Nose Drops (Neo-Synephrine): These are sold OTC. Blow your nose to clean out the mucus before using. Spray each nostril once. Wait one minute and then spray a second time.
  • Read all package instructions.
Pain and Fever Medicines:
  • For pain or fever relief, take acetaminophen or ibuprofen.
  • Treat fevers above 101°F (38.3°C).
  • The goal of treating a fever is to bring it down. These medicines most often lower fever about 2-3°F (1-1.5°C).
  • You can take one of the drugs listed below if you have pain or a fever.
  • They are over-the-counter (OTC) drugs. You can buy them at the drugstore.
Acetaminophen (Tylenol):
  • Regular Strength: Take 2 pills (650 mg) every 4-6 hours. Each Regular Strength pill has 325 mg of acetaminophen.
  • Extra Strength: Take 2 pills (1,000 mg) every 8 hours. Each Extra Strength pill has 500 mg of acetaminophen.
  • Do not take more than 3,000 mg of this drug per day.
Ibuprofen (Motrin, Advil):
  • Motrin and Advil: Take 2 pills (400 mg) every 6 hours. Each Motrin or Advil pill has 200 mg of ibuprofen.
  • A different option is to take 3 pills (600 mg) every 8 hours.
Extra Notes:
  • Use the lowest amount of a drug that makes your pain feel better.
  • Your doctor might tell you to take more than what is shown above. That is because your doctor knows you and your health problems.
  • Acetaminophen is safer than ibuprofen in people over 65 years old. Acetaminophen is in many OTC and prescription drugs. It might be in more than one drug you are taking. Be careful how much you take. Too much of this drug can hurt the liver.
  • Caution- Acetaminophen: Do not take it if you have liver disease.
  • Caution- Ibuprofen:
    • Do not take ibuprofen if you are pregnant.
    • Do not take this drug if you have stomach problems or kidney disease.
    • Do not take this drug for more than 7 days without checking with your doctor.
  • Read all package instructions.
What to Expect:
  • Sinus congestion from colds most often lasts 5-10 days.
  • Sometimes, a cold can worsen and turn into bacterial sinusitis. Sinus symptoms will last more than 10 days. Your pain will get worse. You will also have a fever lasting more than 3 days. You may need antibiotics.
Call Your Doctor If:
  • Severe pain lasts more than 2 hours after pain medicine
  • Sinus pain lasts more than 1 day after starting treatment using nasal washes
  • Sinus congestion lasts more than 10 days
  • Fever lasts more than 3 days
  • You get worse

Neti Pot for Sinus Symptoms

Neti Pot:
  • The Neti Pot is a small pot with a thin spout. It looks like a small tea pot.
  • How It Helps: You can use the Neti Pot for a nasal wash. The salt water rinses out mucus, dust, and allergens. It also keeps the nose moist.
  • Indications: Neti Pots are used to help colds, sinus infections, and nasal allergies.
  • Adverse Reactions: None. Though, not all people like the feeling of pouring water into their nose.
  • See Internet videos such as: http://www.youtube.com/watch?v=j8sDIbRAXlg
Neti Pot STEP-BY-STEP Instructions:
  • Step 1: Follow the directions on the salt package to make warm salt water.
  • Step 2: Lean forward and turn your head to one side over the sink. Keep your forehead slightly higher than your chin.
  • Step 3: Gently insert the spout of the Neti Pot into the higher nostril. Put it far enough so that it forms a comfortable seal.
  • Step 4: Raise the Neti Pot slowly. The salt water flows in your higher nostril and out the lower nostril. Breathe through your mouth.
  • Step 5: When the Neti Pot is empty, blow your nose. This will clean out the water and mucus.
  • Step 6: Some of the water may run into the back of your throat. Spit this out. If you swallow the salt water it will not hurt you.
  • Step 7: Refill the Neti Pot and repeat on the other side. Again, breathe out strongly to clear the nose.
How to Make Saline (Salt Water) Nasal Wash:
  • You can make your own salt water nasal wash.
  • Add 1/2 tsp of table salt to 1 cup (8 oz.; 240 ml) of warm water.

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

Author and Senior Reviewer: David A. Thompson, M.D.

Copyright 2000-2013. Self Care Decisions LLC; LMS, Inc.