Sinus Pain and Congestion

A sensation of fullness, pressure and pain on the face overlying a sinus cavity (e.g., above the eyebrow, behind the eye, around the eye or over the cheekbone). Pain or pressure may be bilateral (on both sides of face), but more often is unilateral (on one side of the face). Associated symptoms are a blocked nose, nasal discharge and/or postnasal drip.


  1. Infection: Sinus opening(s) becomes blocked by an infection or nasal allergy.
  2. Viral Sinusitis: Sinusitis can occur as part of a viral upper respiratory infection (e.g., rhinosinusitis or the common cold). The viral infection and inflammation of the lining of the nose can also affect the lining of all the paranasal sinuses.
  3. Bacterial Sinusitis: Approximately 1-2 percent of viral sinusitis cases progress to become bacterial sinusitis; one or more of the sinuses affected with viral sinusitis becomes secondarily infected with bacteria. Distinguishing symptoms are symptoms lasting longer than 10 days, increasing sinus pain, and the return of fever.
  4. Allergic Sinusitis: When an allergen (e.g., pollen) activates the lining of the nose (allergic rhinitis), sinus congestion may occur due to swelling of the sinus passage openings (ostia). Symptoms suggesting an allergic etiology include sneezing, itchy nose, clear nasal discharge, and itchy watery eyes.
  5. Rhinitis Medicamentosa: Prolonged continuous use of more than five days of decongestant nose drops can lead to “rebound” congestion where the nose becomes even more stuffy.


  1. Viral Sinusitis: Saline nasal washes. Antibiotics are not helpful.
  2. Bacterial Sinusitis: Saline nasal washes. Oral antibiotics may be needed.
  3. Allergic Sinusitis (Hay Fever): Oral antihistamines can relieve mild to moderate symptoms. Examples include diphenhydramine (Benadryl), loratadine (Claritin, Alavert), fexofenadine (Allegra), and cetirizine (Zyrtec). Nasal corticosteroid sprays are probably the most effective treatment for allergic rhinitis. Saline nasal washes are also helpful.

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