Sinusitis feels like a cold that won’t quit, with added pressure and pain in your face. The hallmark signs are thick, discolored nasal discharge combined with facial pain or pressure, congestion, and a reduced sense of smell. If you have at least two of those symptoms, and they’ve lasted longer than a typical cold, you’re likely dealing with a sinus infection. Most cases are diagnosed based on symptoms alone, without any imaging or lab tests.
The Core Symptoms to Look For
Clinical guidelines break sinusitis symptoms into two tiers. The major symptoms are the ones that point most strongly toward a sinus infection:
- Thick, discolored nasal discharge (yellow, green, or cloudy)
- Nasal congestion or blockage
- Facial pain or pressure, especially around the cheeks, forehead, or between the eyes
- A feeling of fullness in the face
- Reduced or lost sense of smell
- Fever
A second group of minor symptoms can also show up: headache, ear pain or pressure, aching in your upper teeth, bad breath, cough, and fatigue. The general diagnostic rule is two major symptoms, or one major symptom plus two or more minor ones.
Not every symptom needs to be present. Some people get intense facial pressure with barely any discharge. Others have a constantly dripping nose but only mild pressure. The combination matters more than any single symptom.
A Simple Self-Check for Sinus Tenderness
You can get a rough sense of sinus involvement by gently pressing on the areas where your sinuses sit. Using your thumb in a small circular motion, press just below your eyebrows along the bony ridge above your eyes (avoiding the eye socket itself). Then press just below your cheekbones, slightly to the side of your nose. A mild sense of pressure is normal. If either spot feels genuinely painful or tender, that’s a sign of sinus inflammation. It’s not a definitive test, but combined with other symptoms, it adds useful information.
Cold, Sinusitis, or Migraine?
The trickiest part of identifying sinusitis is separating it from the conditions it mimics. A regular cold and a sinus infection start the same way, so timing becomes the key differentiator. Cold symptoms typically peak around days three to five and then start improving. If your symptoms hold steady or worsen past the 10-day mark with no improvement, a sinus infection is the more likely explanation.
Migraine is the other major source of confusion. About 90% of people who believe they have a “sinus headache” actually have migraines, according to research from the American Migraine Foundation. This happens because the nerves activated during a migraine are the same ones that supply the sinuses, eyes, ears, and jaw. Nearly half of migraine sufferers experience nasal congestion or watery eyes during an attack, which makes the overlap feel convincing.
A few clues help sort this out. Migraine pain tends to throb or pulse, gets worse with physical movement, and often comes with nausea, vomiting, or sensitivity to light, noise, and smells. Sinusitis pain is more of a constant, deep pressure that stays put in one area of your face. And the giveaway for sinusitis is that thick, discolored discharge. If your nose is running clear or not running at all, and you’re sensitive to light, you’re more likely dealing with a migraine.
Viral vs. Bacterial: Does It Matter?
It matters because the distinction determines whether antibiotics will help. Most sinus infections start as viral infections, and antibiotics do nothing for a virus. Three patterns suggest the infection has become bacterial:
- Symptoms lasting 10 days or more without any improvement
- Severe onset: a fever of 102°F or higher along with facial pain and discolored nasal discharge lasting three to four consecutive days
- The “double worsening” pattern: your symptoms start to improve after four to seven days, then suddenly get worse again
If none of these patterns apply, your sinus infection is almost certainly viral. It will feel miserable, but it should resolve on its own within 10 days. Saline rinses, staying hydrated, and over-the-counter pain relievers can help you get through it.
How Long Each Type Lasts
Sinusitis is classified by how long it drags on. Acute sinusitis lasts up to four weeks and is the most common type. Subacute sinusitis lingers between four and 12 weeks, often because an acute case never fully cleared. Chronic sinusitis persists for 12 weeks or longer, sometimes with symptoms that wax and wane but never fully disappear. Some people also develop recurrent acute sinusitis, defined as four or more separate episodes per year, each lasting seven to 10 days.
If your symptoms keep returning or never seem to fully resolve, that pattern itself is worth paying attention to. Chronic and recurrent sinusitis can involve structural issues like nasal polyps or a deviated septum, allergies, or immune system factors that keep the cycle going.
When Imaging Is and Isn’t Needed
You generally don’t need a CT scan or X-ray to confirm sinusitis. Guidelines from both CMS and the American College of Radiology are explicit: most uncomplicated cases are diagnosed based on your symptoms and a physical exam. Imaging is reserved for situations where a complication is suspected (like the infection spreading toward the eyes or brain), when symptoms are atypical, or when you have risk factors like diabetes, a weakened immune system, or a history of facial surgery or trauma.
Symptoms in Children
Kids get sinusitis too, but it can look a little different. Cough is a more prominent symptom in children than in adults. The typical pattern is a cold that simply refuses to improve after 10 days. Children are less likely to describe facial pressure in specific terms, so a persistent cough, ongoing nasal congestion, and irritability after what seemed like a normal cold are the main clues.
Red Flags That Need Immediate Attention
Sinus infections rarely become dangerous, but when they do, the infection can spread to nearby structures. Get medical care right away if you notice any of the following:
- Pain, swelling, or redness around the eyes
- High fever
- Double vision or other changes in your eyesight
- Confusion
- A stiff neck
These can signal that the infection has moved toward the eye socket or the brain, both of which require urgent treatment. This is uncommon, but the symptoms are distinctive enough to watch for.