The hallmark symptoms of sinusitis are a stuffy nose, thick discolored nasal discharge, and pain or pressure in the face, particularly around the eyes, cheeks, and forehead. These symptoms result from inflamed, swollen sinuses that can no longer drain properly. Most cases start with a viral infection and clear up within a few weeks, but symptoms lasting 12 weeks or longer point to chronic sinusitis, which requires a different approach.
The Core Symptoms
Sinusitis produces a cluster of symptoms that tend to show up together. The most common are:
- Thick, discolored nasal discharge. Yellow or greenish mucus draining from your nose or sliding down the back of your throat (postnasal drip).
- Nasal congestion. A blocked or stuffy nose that makes breathing through your nostrils difficult.
- Facial pain and pressure. Tenderness, swelling, or a heavy pressure sensation around the eyes, cheeks, nose, or forehead that typically worsens when you bend forward.
- Reduced sense of smell. A noticeably weaker ability to smell, or a complete loss of smell.
Beyond these four cardinal symptoms, sinusitis commonly causes ear pressure, headache, aching in the upper teeth, cough, bad breath, and fatigue. A low-grade fever can appear, especially with bacterial infections.
Why Your Face Hurts
Your sinuses are lined with tissue that constantly produces a thin layer of mucus. Tiny hair-like structures called cilia sweep that mucus toward small drainage openings that connect to your nasal passages. When infection or allergies cause the lining to swell, those openings narrow or close entirely, trapping mucus inside the sinus cavities.
Trapped mucus creates direct pressure against the walls of the sinus, which is why the pain maps so precisely to your face. Pressure behind your cheekbones means the maxillary sinuses are involved. Pain between or above the eyes points to the ethmoid or frontal sinuses. The swelling also blocks fresh air from reaching the sinuses, creating a vacuum effect that adds to the heavy, full-face feeling. Once drainage is blocked, bacteria can multiply in the stagnant mucus, which worsens inflammation and continues the cycle.
Acute vs. Chronic Sinusitis
Acute sinusitis lasts up to four weeks and is usually triggered by a cold. The symptoms are the same core set: colored nasal discharge, congestion, facial pain, and reduced smell. Most people recover without antibiotics.
Chronic sinusitis involves the same symptoms persisting for at least 12 consecutive weeks. The pain and pressure may be less intense than in an acute episode, but the congestion, postnasal drip, and dulled sense of smell grind on. People with chronic sinusitis often describe a baseline of low-level stuffiness punctuated by flare-ups that feel like a fresh sinus infection. Diagnosis requires at least two of the four cardinal symptoms plus objective evidence of inflammation, typically seen on a CT scan or during a nasal exam.
Viral or Bacterial: How to Tell the Difference
For the first three to four days of a sinus infection, there’s no reliable way to distinguish a viral cause from a bacterial one. The symptoms look identical. The timeline is what matters most.
A viral sinus infection typically peaks around days three to five, then gradually improves. A bacterial infection follows one of two patterns. The first is persistence: symptoms that plateau and show no improvement whatsoever after 10 days. Once you’ve passed the 10-day mark without getting better, the probability of a bacterial cause rises to about 60%. The second pattern, sometimes called “double sickening,” is when you start to improve and then get noticeably worse again between days 5 and 10. That rebound, often with returning fever, worsening facial pain, and thicker nasal discharge, is one of the strongest signals of a bacterial infection.
Thick, colored mucus alone does not mean you have a bacterial infection. Viral sinusitis produces discolored discharge too. The combination of persistent symptoms beyond 10 days, pus visible in the nasal cavity, and that double-sickening pattern is far more telling.
Sinusitis Symptoms in Children
Children get sinusitis frequently, but they don’t always describe their symptoms the way adults do. In kids, the most noticeable signs are often a persistent cough (especially at night), a runny or stuffy nose that won’t quit, bad breath that doesn’t improve with brushing, and postnasal drip that triggers constant throat clearing. Facial swelling, fever, and headache can appear as well.
Behavioral changes are worth watching for. A child who seems unusually irritable, fatigued, or just “off” alongside nasal symptoms may be dealing with sinus inflammation. As with adults, symptoms that worsen around the 7- to 10-day mark rather than improving suggest a bacterial infection has developed on top of the original cold.
Sinus Headache vs. Migraine
About 90% of people who believe they have a sinus headache actually have a migraine. The confusion is understandable: migraines activate the same nerves that supply the sinuses, eyes, ears, and teeth, so a migraine can genuinely cause nasal congestion, a runny nose, watery eyes, and facial pressure. One study found that 45% of migraine sufferers had nasal congestion or watery eyes during an attack.
The key differences come down to the character of the pain and the accompanying symptoms. Migraine pain is typically throbbing or pulsating, worsens with physical activity, and comes with nausea, vomiting, or sensitivity to light, noise, and smells. True sinus headache pain is more of a steady pressure or fullness behind the cheekbones and around the eyes, and it’s accompanied by thick, discolored nasal discharge and sometimes fever. If you don’t have that discolored discharge, a sinus headache is unlikely.
Timing also helps. Sinus headache pain should resolve within about seven days after the underlying infection clears, whether on its own or with treatment. If the pain keeps returning without other signs of infection, migraine is a more likely explanation.
Symptoms That Need Urgent Attention
Most sinusitis is uncomfortable but not dangerous. A small number of cases, however, can spread to surrounding structures. Swelling or redness around the eyes, a severe headache that doesn’t respond to typical remedies, high fever, double vision, a stiff neck, or confusion are signs that the infection may be affecting the eye socket or the central nervous system. These symptoms warrant immediate medical evaluation.