The hallmark symptoms of a sinus infection are facial pain or pressure, thick discolored nasal discharge, and congestion that persists well beyond a typical cold. Most sinus infections start as viral illnesses, with 90% to 98% of cases caused by viruses rather than bacteria. Knowing what to look for helps you tell the difference between a lingering cold and something more significant.
The Core Symptoms
A sinus infection, also called sinusitis, produces a recognizable cluster of symptoms that tend to show up together. The most common include:
- Thick, cloudy, or colored nasal discharge (yellow, green, or white)
- Stuffy or blocked nose
- Pain, pressure, or fullness in the face, around the eyes, or across the forehead
- Reduced or lost sense of smell and taste
- Headache
- Fatigue
- Bad breath
- Fever
The facial pain often gets worse when you bend forward or strain. Your cheeks, forehead, or the area between your eyes may feel tender to the touch. The pain can also radiate to your temples, the top of your head, or the back of your skull, depending on which sinuses are affected.
Symptoms You Might Not Expect
Some sinus infection symptoms catch people off guard because they don’t seem related to the nose at all.
Toothache is one of the most common surprises. Your largest sinuses sit directly above the roots of your upper back teeth. When those sinuses become inflamed, the pressure and swelling can cause aching in the upper teeth that feels like a dental problem. This is a fairly common symptom, not a rare one.
Ear pain or a feeling of fullness in the ears is another. The sinuses and ears share drainage pathways, so inflammation in one area easily affects the other. Postnasal drip, where mucus runs down the back of your throat, can trigger a persistent cough and a sore or irritated throat, especially at night. Some people notice their voice sounds different or that they keep needing to clear their throat.
Why You Lose Your Sense of Smell
A dulled or completely absent sense of smell is one of the more disruptive symptoms. It happens for two reasons. First, swelling inside the nasal passages physically blocks odor molecules from reaching the smell receptors high up in your nose. Second, the inflammation itself can damage the delicate lining where those smell receptors live, causing the sensory cells to break down. Since most of what you perceive as taste actually comes from smell, food often tastes bland or off during a sinus infection. In acute infections, smell typically returns as the swelling resolves. In chronic cases lasting months, the damage to the sensory lining can make recovery slower.
How It Differs From a Cold
Colds and sinus infections share many symptoms, which is why it’s easy to confuse them. A cold typically improves on its own within 7 to 10 days. A sinus infection tends to announce itself when you start feeling worse instead of better after that 10-day mark, or when symptoms plateau and refuse to budge.
The two biggest distinguishing features are facial pressure and discolored drainage. A cold can cause a runny nose, but the discharge is usually thin and clear. With a bacterial sinus infection, it turns thick and yellow-green. Significant facial pain or pressure across the cheeks and around the eyes also points more toward sinusitis than a simple cold. If your symptoms haven’t improved after 10 to 14 days, or if they worsen after initially getting better, that pattern strongly suggests a sinus infection has developed on top of the original cold.
When It’s Actually a Migraine
About 90% of people who believe they have sinus headaches are actually experiencing migraines. This is a strikingly common misdiagnosis. Migraines can cause nasal congestion, watery eyes, and facial pressure, which is why they’re so easy to mistake for sinus problems. One study found that 45% of migraine sufferers had nasal congestion or watery eyes during an attack.
A true sinus headache comes with thick, discolored nasal discharge and resolves within about seven days as the infection clears. Migraines, on the other hand, cause moderate to severe throbbing pain that worsens with physical activity, along with nausea, vomiting, and sensitivity to light, noise, or smells. If your “sinus headaches” keep coming back but never involve colored mucus or fever, a migraine is far more likely.
Symptoms in Children
Kids don’t always describe sinus symptoms the way adults do, and their presentation looks a bit different. A cold lasting more than 10 to 14 days, sometimes with a low-grade fever, is often the first sign. Children more commonly show irritability, low energy, and swelling around the eyes. Bad breath is another strong clue in kids, along with thick yellow-green drainage and a cough that may worsen at night from postnasal drip. That postnasal drip can also cause nausea or vomiting. Headache is a reliable symptom in children over age six, but younger children are more likely to just seem cranky and tired.
Acute vs. Chronic Sinusitis
Acute sinusitis is the more common form. It typically resolves within 10 days, or within a few weeks if a bacterial infection develops. The symptoms are the same ones described above, and they tend to be intense but short-lived.
Chronic sinusitis is diagnosed when symptoms last 12 weeks or longer. The symptoms are similar but often less severe on any given day. Instead of sharp facial pain and high fever, chronic sinusitis tends to produce a persistent dull pressure, ongoing postnasal drip, a reduced sense of smell that doesn’t fully return, and general fatigue. Nasal polyps, which are soft growths inside the sinuses, are a common contributor to the chronic form and can worsen congestion and smell loss over time.
Serious Warning Signs
Most sinus infections resolve on their own or with straightforward treatment, but a small number develop into something more dangerous. The sinuses sit close to the eyes and the brain, so infection can occasionally spread to those areas.
Seek immediate medical attention if you notice any of these:
- Swelling, redness, or pain around the eyes
- Double vision or other vision changes
- High fever
- Stiff neck
- Confusion
If the infection spreads to the eye socket, it can threaten vision. These complications are uncommon, but they require urgent care. Swelling around the eyes is especially concerning in children with sinus infections and should not be dismissed as normal.