A sinus infection has two hallmarks: cloudy or colored nasal discharge lasting up to four weeks, combined with either a stuffy, blocked nose or pain and pressure in your face, head, or around your eyes. If you have both of those features, you likely have acute sinusitis. But knowing whether it’s a simple cold that will pass on its own or something that needs treatment comes down to a few key details, especially timing.
The Core Symptoms to Look For
Your sinuses are air-filled pockets in your skull, and when they get inflamed or infected, the symptoms follow a predictable pattern. The most telling sign is nasal discharge that’s cloudy, yellow, or green rather than clear and watery. On its own, though, that discharge doesn’t confirm a sinus infection. It needs to come alongside at least one of these:
- Nasal blockage: a stuffy, congested feeling that makes it hard to breathe through your nose
- Facial pain or pressure: a dull ache or fullness in your forehead, cheeks, or around your eyes
Other common symptoms include a reduced sense of smell, aching in your upper teeth, fatigue, and postnasal drip (mucus running down the back of your throat, which can trigger a cough). A low-grade fever is possible but not always present.
Where You Feel the Pain Matters
You have four pairs of sinuses, and the location of your pain can tell you which ones are inflamed. Forehead pain points to the frontal sinuses. Cheekbone pain or aching in your upper teeth suggests the maxillary sinuses, the largest pair, sitting just below your eyes. Pain at the bridge of your nose involves the ethmoid sinuses. Pain deep behind your eyes or in your ears can mean the sphenoid sinuses are affected.
You can do a simple check at home: press gently on these areas with your fingertips. If pressing on your cheekbones, the bridge of your nose, or your forehead produces a dull, tender ache that worsens with the pressure, that’s consistent with sinus inflammation. The pain often feels worse when you bend forward or lie down, because those positions increase pressure in the swollen cavities.
Viral or Bacterial: Why Timing Is Everything
Here’s something most people don’t realize: yellow or green mucus is not a reliable sign of a bacterial infection. Both viral and bacterial infections can produce thick, discolored mucus. Even your doctor can’t tell the difference based on symptoms or an exam alone. The main clue is how long your symptoms last and how they behave over time.
A viral sinus infection, which is far more common, typically starts improving after five to seven days. A bacterial sinus infection persists for seven to ten days or longer, and often gets worse after the first week rather than better. The Infectious Diseases Society of America uses three specific patterns to identify a likely bacterial infection:
- Persistent symptoms: no improvement at all after 10 days
- Severe onset: fever of 102°F or higher with facial pain and colored nasal discharge lasting three to four consecutive days
- Double worsening: symptoms seem to improve after four to seven days, then come back worse
That “double worsening” pattern is particularly telling. If you felt like you were getting better, then suddenly spiked a new fever or your congestion and pain returned with more intensity, a bacterial infection has likely set in on top of the original viral one. This is the point where antibiotics become appropriate. For a standard viral sinus infection, antibiotics do nothing.
Sinus Infection vs. a Cold
Every sinus infection starts out looking like a common cold, which makes the first few days impossible to distinguish. Colds bring sneezing, a runny nose, mild congestion, and sometimes a sore throat. Most colds resolve within seven days, though they can linger longer. A sinus infection announces itself when the cold symptoms don’t fade on schedule, or when facial pressure and thick, discolored discharge become the dominant features rather than the sneezing and watery nose you started with.
The key difference is progression. A cold gets gradually better day by day. A sinus infection either plateaus or worsens, and the pain and pressure in your face become more pronounced rather than fading.
It Might Actually Be a Migraine
About 90% of people who think they have a sinus headache actually have a migraine. That statistic sounds surprising, but migraines can cause nasal congestion, a runny nose, and facial pressure, symptoms most people associate with their sinuses rather than a neurological condition.
Three questions can help sort this out. In the past three months: Do your headaches interfere with your ability to function? Do you feel nauseous during the headache? Do you become sensitive to light? If you answer yes to two of those three, there’s a 93% chance your problem is migraine, not sinusitis.
Other migraine clues include throbbing or pulsating pain that worsens with movement, vomiting, and sensitivity to noise or smells. A true sinus headache, by contrast, comes with steady pressure (not throbbing), weaker sense of smell, and usually a fever. If your “sinus headaches” keep recurring without the colored mucus and congestion that define a sinus infection, migraine is worth investigating.
Sinus Infections in Children
Kids don’t always present the same way adults do. Young children rarely complain about facial pressure the way adults can articulate it. Instead, the main signs are a combination of nasal discharge and a daytime cough that lasts more than 10 days without improving. Since ordinary colds in children usually resolve within seven days (though they can last longer), that 10-day mark is the practical dividing line. A child who still has a thick, runny nose and persistent cough beyond 10 days, with no sign of getting better, likely has a bacterial sinus infection rather than a lingering cold.
When It Won’t Go Away: Chronic Sinusitis
If your symptoms persist for 12 weeks or more, you’ve crossed into chronic sinusitis territory. Chronic sinusitis isn’t just a long cold. It’s ongoing inflammation in the sinuses that can be caused by nasal polyps, a deviated septum, allergies, or repeated infections. The symptoms are similar to acute sinusitis (congestion, facial pressure, reduced smell, postnasal drip) but tend to be less intense and more constant, a low-grade misery rather than the sharp, obvious illness of an acute infection. Fever is less common with the chronic form. If you’ve been dealing with congestion and facial pressure for months, this is a different condition that requires evaluation beyond what home care can address.
Symptoms That Need Immediate Attention
Sinus infections rarely become dangerous, but when they do, the infection can spread to nearby structures like the eyes or brain. Get medical attention immediately if you develop any of these alongside your sinus symptoms:
- Swelling, redness, or pain around one or both eyes
- Double vision or other sudden vision changes
- High fever that won’t respond to treatment
- A stiff neck
- Confusion or difficulty thinking clearly
These symptoms are rare, but they can signal that the infection has spread beyond the sinuses and needs urgent treatment.