I’m Experiencing Sinus Issues. What Should I Do?

Dr. Franklyn Gergits, ENT

Short answer: Start with high-volume saline irrigation twice daily, a daily intranasal corticosteroid spray, and supportive care. If symptoms have not improved after ten days, if you have had two or more similar episodes in the past year, or if antibiotics have already failed you — stop managing at home and get a proper evaluation. That means nasal endoscopy and a CT scan, not another empiric antibiotic prescription. Most sinus symptoms do not require antibiotics. What they require is an accurate diagnosis — and that is where most patients are being failed.

This is exactly the right question to ask before you do anything else — because what you do first matters more than most people realize. The most common first response to sinus symptoms is an antibiotic. And in most cases, it is the wrong call. Not because your doctor is wrong, but because the diagnosis has not been confirmed yet.

Here is how to think through this properly.

First — Confirm That You Actually Have Sinusitis

Sinusitis means inflammation of the sinuses — and it has a specific symptom pattern. You are looking for nasal obstruction or congestion, discolored nasal drainage, facial pressure or fullness, and reduced sense of smell. The key timing marker: symptoms lasting more than ten days without improvement, or symptoms that improve and then suddenly worsen.

If your symptoms started less than ten days ago and are getting better, this is most likely a viral upper respiratory infection. It will resolve on its own. An antibiotic will not help it and may cause harm by disrupting the bacterial balance in your sinuses. Patience and supportive care are the right moves at this stage.

You also want to consider your allergy history. Many patients who believe they have recurrent sinus infections are actually experiencing undertreated allergic rhinitis — chronic nasal inflammation driven by allergens rather than infection. If you have a known allergy history, that context is important before any treatment decision is made. Note that nonallergic or vasomotor rhinitis — nasal congestion and pressure driven by irritants, temperature changes, or other non-allergic triggers — is a distinct condition that is less responsive to nasal corticosteroids and requires a different treatment approach.

Could It Be Migraine — Not Sinusitis?

This is the question that most patients with chronic sinus pressure have never been asked. Studies consistently show that 50 to 80 percent of patients presenting with what they or their physician call a “sinus headache” actually have migraine. A landmark study found that 88 percent of patients with self-reported or physician-diagnosed “sinus headache” met criteria for migraine. The mechanism is well understood: migraine activates the trigeminovascular system, producing genuine nasal symptoms — congestion, rhinorrhea, and facial pressure — through parasympathetic activation. These patients feel real sinus pressure. Their sinuses are not the problem.

The features that point toward migraine rather than sinusitis: nausea during the pressure episode, sensitivity to light or sound, sensitivity to smells, and a normal nasal endoscopy and CT scan. If your sinus pressure has never fully responded to antibiotics, antihistamines, or nasal sprays — and particularly if it tracks with weather changes — migraine belongs in the conversation before any further sinus-directed treatment is pursued.

What to Do Right Now at Home

Start with high-volume nasal saline irrigation — 240ml twice daily using a squeeze bottle like NeilMed. This is the single most evidence-based first step you can take. It physically removes inflammatory mediators, allergens, and pathogens from the nasal mucosa. It costs almost nothing and has no downside.

Add a daily intranasal corticosteroid spray — fluticasone (Flonase), budesonide (Rhinocort), or triamcinolone (Nasacort) are all available over the counter. Use it every day, not as needed. These reduce mucosal swelling and are appropriate whether your problem is sinusitis, allergic rhinitis, or both.

For congestion, pseudoephedrine — available behind the pharmacy counter without a prescription — can open the nasal passages and improve drainage. Use with caution if you have heart disease, uncontrolled hypertension, or glaucoma — check with your pharmacist or physician first. For facial pain and pressure, ibuprofen or acetaminophen provide meaningful relief. If you have known seasonal allergies, adding a non-sedating antihistamine such as loratadine or cetirizine is appropriate — note that antihistamines are not recommended for sinus symptoms in patients without allergic disease as they may worsen congestion.

Stay well-hydrated. Adequate hydration may help keep mucus thinner and more mobile, particularly in dry climates like Arizona. There is no specific fluid formula supported by the clinical evidence — general adequate daily hydration is a reasonable goal.

When to Stop Managing at Home and See a Specialist

If your symptoms have not improved after ten days of the above, if you have had two or more similar episodes in the past year, or if you have already been prescribed antibiotics with no lasting relief — it is time for a proper evaluation. That means nasal endoscopy and a CT scan of the sinuses. These two studies together confirm whether chronic rhinosinusitis is present, how extensive it is, and what is driving it.

Do not accept another empiric antibiotic without a culture first. Most antibiotic prescriptions for sinus complaints are written without one, which means the treatment is a guess. A rhinologist can confirm the diagnosis, identify what is actually driving your symptoms — whether that is anatomy, allergy, immune dysregulation, or something upstream like silent reflux — and match the treatment to the actual cause rather than the assumed one.

When to Seek Immediate Care

Most sinus symptoms are uncomfortable but not dangerous. However, certain symptoms require emergency evaluation rather than a scheduled appointment — periorbital swelling or redness around the eye, double vision or any change in vision, severe headache that is different from your usual headaches, high fever with facial pain, new neurological symptoms, or nosebleeds that will not stop. These can indicate a complication of sinusitis that requires urgent treatment. Do not wait for these to resolve on their own.

Want to Understand More?

This post is part of the Understanding Your Symptoms series on the Airway & Sinus Wellness Review.

→Why Antibiotics Keep Failing Your Sinus Infection

→Can Sinusitis Cause Daily Headaches?

→Why Do I Keep Getting Sinus Infections After Surgery?

→Airway & Sinus Wellness Review — Full Publication

This post is part of the Understanding Your Symptoms section of the Airway & Sinus Wellness Review.

References

1. Piccirillo JF, Payne SC, Rosenfeld RM, et al. Clinical Practice Guideline: Adult Sinusitis Update. Otolaryngology–Head and Neck Surgery. 2025. entnet.org

2. Schreiber CP, Hutchinson S, Webster CJ, et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. Archives of Internal Medicine. 2004. 88% met migraine criteria.

3. Bernichi JV, Rizzo VL, Villa JF, et al. Rhinogenic and sinus headache — literature review. American Journal of Otolaryngology. 2021. 50–80% of “sinus headache” is migraine.

4. Chow AW, Benninger MS, Brook I, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis. Clinical Infectious Diseases. 2012. idsociety.org

5. Centers for Disease Control and Prevention. Antibiotic prescribing and use — sinus infection. CDC.gov

6. Keating MK, Phillips JC. Chronic Rhinosinusitis. American Family Physician. 2023. AAFP.org Alarm symptoms and urgent referral criteria.

7. Bernstein JA, Bernstein JS, Makol R, Ward S. Allergic rhinitis: a review. JAMA. 2024. Allergic vs nonallergic rhinitis distinction; pseudoephedrine safety qualifiers.

About the Author

Dr. Franklyn R. Gergits, MBA, DO, FAOCO is a Board-Certified Otolaryngologist and Fellowship-Trained Otolaryngic Allergist with a Clinical Focus in Rhinology and Airway Disorders and over 30 years of clinical experience. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale, where he performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK® posterior nasal nerve ablation, and Eustachian tube dilation under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania and holds dual Entellus Centers of Excellence certifications. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis — a clinical framework identifying pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis. Preprint available at Preprints.org (DOI: 10.20944/preprints202603.0858.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. If you are experiencing severe symptoms including orbital swelling, high fever, vision changes, or stiff neck, seek immediate medical care.