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The paranasal sinuses are a set of four hollow areas, which surround the nasal cavity. The true purpose of these sinuses is still debated, and it is possible that they really serve no biological function at all. However, being joined by a small area known as the ostia, these sinus areas can become easily blocked by allergic inflammation or by nasal lining swelling which occurs during a cold or flu. Knowing the options and what to do for severe sinus pain can quickly alleviate pain and discomfort. When this occurs, the normal process of mucus drainage can be disrupted resulting in a condition known as sinusitis. Another condition which may effect the sinus cavity areas is an infection of the posterior teeth, since they are close to the maxillary sinus.


healthy and inflamed sinuses

Inflammation of the four sinus cavities depicted in the above diagram is the root cause of sinusitis.

Symptoms of sinusitis (both acute and chronic)

These symptoms are normally headaches and facial pain in the form of a constant, dull aching sort. The discomfort is generally over the area of the affected sinus. The discomfort will often begin on one side of the face and progress to the other. The pain will grow in levels of discomfort when the person with the infection is bending over or lying down. A thick, greenish, nasal discharge is often present. Localized headaches and/or toothaches may occur. The prevalence and existence of sinusitis continues to increase so that up to 40 million Americans suffer at least one sinus infection every year.

sinusitis example

Infection of the sinus cavities causes the onset of sinusitis symptoms, like painful congestion, headache, toothache or sinus pressure.

Sinus infections can very rarely result in eye socket infections, brain infections, and infections of the inner ear. These are due to major congestion of the nasal passages and can be very serious. You should seek medical attention if you feel you may have a severe sinus infection.

 Sinus Headaches vs. Migraines


Placing a warm, damp washcloth over your forehead may help soothe a sinus headache.

Sinus headaches are often confused with migraines.  It is easy to confuse the two as the migraine headache is a result of the activation of the trigeminal nerves that stimulate the sinus regions as well as the meninges encasing the brain. As such, it is very difficult to determine exactly where the original pain is extending from. To confuse matters even further, a migraine headache will often cause a runny nose and eye tearing, so the symptoms often look very similar. Patients with complaints of “sinus” headaches often reported treatments such as decongestants and/or antibiotics being ineffectual while treatment with migraine medications result in relief. However, patients with migraines do not report the thick, greenish nasal discharge which is typically seen with true sinus infection (sinusitis).

According to the 2007 edition of the Clinical Practice Guideline: adult sinusitis, with sinusitis symptoms lasting less than 7 days, is assumed to be viral in nature, while symptoms lasting more than 10 days are assumed to be bacterial acute sinusitis. Learn more about Viral vs. Bacterial sinus infections.

 Chronic Sinusitis

Chronic Sinusitis is considered when the symptoms last past the 12 week mark. If you have not improved with medication such as antibiotics and nasal steroids, a CT scan may be used to investigate. Cultures of the sinus mucus have been shown over time to not be very helpful in determining the type of bacteria you have. Endoscopy of the sinuses is needed and can provide information about the anatomy of the nose including sinus polyps, a deviated nasal septum, or draining mucopus.

What to do for Severe Sinus Pain

Whether chronic or acute, treatment will generally begin with nasal irrigation or a decongestant nasal spray (something like oxymetazoline is typically acceptable). Caution should be observed as treatment for more than 3 days with oxymetazoline can cause worsened congestion and promote sinusitis. Decongestant pills  (pseudoephedrine) or mucolytics (guaifenesin) can help with congestion and breaking up the mucus. Other treatments may include the use of damp, warm cloths applied to the painful area several times a day, drinking more liquids so that the mucus will thin, and low temperature steam treatments two to four times per day. Acetaminophen (Tylenol) is very good for sinus pain but it can be tough on your liver so only take as directed.


Use a decongestant nasal spray to relieve sinusitis symptoms.

A vast majority of early sinus infections are viral in nature. However, after seven to ten days the use of antibiotics may also be prescribed if symptoms worsen.  Biaxin (clarithromycin) is a common choice as is Augmentin  (amoxicillin/clavulanate) or even a Z-Pak (azithromycin).


To help break up sinus congestion, you can inhale the steam from a bowl of hot water. Remember to take long, slow, deep breaths.


Surgery for Sinus Pain

If relief is not achieved from conservative treatment the use of medications, and a sinus CAT scan shows evidence of sinus inflammation or narrowing, then sinus surgery may be the next step.

There are several different types of surgery techniques currently being used, and new explorations for this common problem continue to be developed. At this time FESS (Functional Endoscopic Sinus Surgery) is the most probable recommendation. FESS is a targeted sinus disease approach using micro-instruments which reduces the likelihood of tissue damage and results in decreased post-operative complications.

FESS is probably the most common surgical procedures performed by the average ear, nose and throat specialist in private practice, and complications are  rare. The procedure is performed in very close proximity to the eyes, optic nerves, internal carotid arteries and brain, so extensive training and experience are required, but again, complications are very rare.

The procedure is done by the insertion of small endoscopes into the nasal cavity to evaluate the sinuses. The telescopes provide visualization, magnification and illumination inside the nose so that your surgeon can identify blockage areas and restore proper drainage.

Another procedure which was recently developed is unblocking the drainage passages with the use of balloons, the balloon sinuplasty. This idea is very similar to the balloon angioplasty used to clear arteries of the heart. The balloons are inserted and expanded to open the sinuses in a less invasive manner than might be experienced with FESS. However, tissue is not removed with the balloon and a FESS may also be required.

Three-Dimensional Imaging uses the sinus CAT scan and an image guidance system to watch the actual CAT scan at the same time as real-time video inside the nose. This can provide and extra layer of safety as well as allowing a more complete surgery.


Sinus pain can be sharp or dull and sporadic or constant. Either way, quality of life is decreased by having these type of headaches and discomfort. For head pain without nasal discharge consider a visit to a neurologist. If you have recurrent acute or chronic sinusitis then see your ENT doctor for an evaluation. Much of the time, pain can be decreased or eliminated which will get you feeling better and more productive quicker.