Many patients seek sinus pain treatment not as a result of the pain itself becoming unbearable, but because it interrupts their ability to think and function, according to researchers. Plainview Hospital otolaryngologist Jay Youngerman, MD, says that some of his older patients see improved cognitive function after successful sinus pain treatment.
A study published in JAMA in April showed that patients with untreated sinus pain had changes in brain activity that could cause cognitive dysfunction on fMRI (functional magnetic resonance imaging) scans. Although that might sound scary to the people who suffer from sinus pain — and there are tens of millions who do — Youngerman, who was not involved in the research, emphasizes that the patients in the study did not actually show cognitive deficits. The brain scans simply suggested a way in which the deficits could occur.
“Untreated sinus disease can lead to visual problems, meningitis, facial and orbital abscesses, nasal obstruction, worsening of asthma, facial anatomical and cosmetic changes, postnasal drip, constant nose blowing and fever,” he adds. If you suffer from sinus pain for more than 10 days without improving, you should see your healthcare provider to diagnose the underlying cause, as this will determine a plan for treatment.
What Are Sinuses?
Sinuses are cavities in your skull, lined with mucus and connected to the nose. Without them, your head would be extremely heavy. When you breathe in, the air gets absorbed by the lining of your sinuses, which then produces small amounts of fluid that either evaporate or drain through your nasal passages and into your throat. But if these passages are blocked by swelling or anatomical abnormalities, a buildup of pressure can cause you pain.
There are some non-pharmaceutical options that may lessen pain temporarily, but if it lasts more than 10 days and isn’t getting better, be sure to see your healthcare provider. You can continue to use these non-drug strategies in conjunction with other treatments for chronic sinus pain.
Non-Pharmaceutical Treatments for Sinus Pain
Cover your head with a towel as you inhale the steam from a bowl of hot water (make sure it’s not so hot, it can scald your face). You can also take a hot shower and breathe in the hot, humid air to help address pain and clear mucus. For some, a humidifier may help.
Rinse Your Nasal Passages Clear
Use a specially designed squeeze bottle or teapot shaped device called a neti pot, to flush your sinus passages with water or saline. (They can be found in most pharmacies.) The water should pass from one nostril to the other and back out. People who have never tried this simple process may find it off-putting at first, but it can be very effective. Called a nasal wash, this technique can help clear a pathway to drain your sinuses. Lean over a sink and tilt your head forward and to the side to try to prevent the liquid from going down your throat.
The Food and Drug Administration (FDA) warns that using nasal rinses can increase the risk of infections if the water/saline holders aren’t cleaned properly. Make sure to follow the instructions and, to limit contamination, use only distilled or water that has been boiled and cooled.
Rub the Pain Away
Massaging your face may relieve pain and even drain some mucus. You can start by using two fingers to lightly massage the areas where you feel pain.
Acupressure may lessen sinus pain. The Cleveland Clinic posted a short video with instructions on how to apply acupressure to your own face to mitigate allergies that cause pain. Or use a licensed acupressurist instead.
If the options above aren’t enough, there are over-the-counter (OTC) remedies that can alleviate pain and break up mucus. However, you should avoid using any of these treatments long term.
Non-Steroidal Anti-Inflammatory Medicines (NSAIDS)
NSAIDS, like Advil and ibuprofen, can lessen pain temporarily if you’re experiencing acute sinus pain because they lower inflammation in your body. Used for only a few hours or a couple of days, the drugs are generally safe. However, Midori Matsuo, bachelor of medicine bachelor of surgery (MBBS) and a pain-management doctor, says, “Many general practitioners don’t know [how] long [patients] can use NSAIDS, but we only recommend using them for 10 days.” After that, they can cause myriad side effects, including:
- Stomach pain, constipation and diarrhea
- Trouble concentrating
- Balance issues
In some cases, you may experience more dangerous side effects like high blood pressure or fluid retention.
Decongestants are available as both oral medications and nasal sprays. These treatments shrink swollen blood vessels and surrounding tissues, relieving pressure and opening airways.
Youngerman emphasizes that these types of drugs should not be used for more than three days because they can cause a “rebound effect,” which means the symptoms will return, sometimes more strongly, after you stop using the drug. Side effects include:
- Stinging in the nose
- Increased mucous production
- Faster or slower heartbeat
Steroid Nasal Sprays
Nasal sprays with corticosteroids can decrease inflammation in your sinuses. Some examples include Nasacort, Flonase and Rhinocort. Oral steroids are known to cause significant side effects, but with the nasal sprays, most side effects are limited to the nostrils, sinuses and throat. They can cause a raw feeling like postnasal drip in those areas along with nosebleeds.
Chronic Sinus Pain
If the pain does become chronic, it could be caused by infection or allergies. Your healthcare provider may suggest some of the following options. While you should see your doctor if your symptoms are severe or last more than 10 days without improving, sinus pain isn’t considered chronic until it lasts longer than three months.
If your sinus pain is the result of a bacterial infection, your doctor will likely recommend antibiotics. If the infection is viral, antibiotics won’t help. In that case, your provider will likely suggest nasal decongestants, like the ones mentioned above. Antibiotics can cause myriad side effects, including:
- Difficulty breathing
- Nausea, vomiting and diarrhea
- Stomach pain
- Swelling of joints
- Stevens-Johnson syndrome (rare skin disorder most often associated with sulfonamides, such as Bactrim)
- Retinal detachment
- Compromised kidney function, associated with fluoroquinolones, such as Cipro, Levaquin (levofloxacin) and Avelox (moxifloxacin)
- Widespread pain
- Heart palpitations
- Muscle spasms
- Antibiotic resistance
Matsuo says allergies tend to be the most common cause of sinus pain. If that’s the case for you, you can limit your exposure to the allergen by staying indoors or reducing dust. In some cases, the face masks we’ve used throughout the pandemic can help. If those strategies don’t provide enough relief, your healthcare provider may prescribe antihistamines or corticosteroids. Be wary of the common OTC Benadryl, though, which is more dangerous than newer options and not recommended for seniors.
Side effects of antihistamines may be:
- Dry mouth, eyes and skin
- Nausea, abdominal pain
- Low blood pressure
- Increased heart rate
Using antihistamines long term, especially the first-generation types, such as Benadryl, can cause other effects, because they also block a neurotransmitter called acetylcholine. A 2015 study in JAMA suggested that taking antihistamines over time could increase your risk of dementia, which is sometimes characterized by a reduction in acetylcholine. Many drugs act on this neurotransmitter, so it’s important to tell your doctor or pharmacist if you’re using allergy medicines, even if they’re OTC.
If you’re using Zyrtec-D or Claritin-D, which are designed to treat congestion along with allergies, you may also experience a faster heart rate.
For Polyps, Deviated Septum or Pain That Doesn’t Respond to Other Treatments
A polyp is a noncancerous tumor, which could be blocking your airway. The septum is the thin piece of bone and cartilage that separates your nasal passages. Birth defects and injuries can push it to the side, where it can inhibit drainage, leading to sinus pain. Surgery can remove polyps or adjust the septum to clear the airways. The surgery is usually short – one to three hours — but does require anesthesia, and the potential risks that come with it, like cognitive impairment. After the surgery, there is a small chance you could experience nosebleeds, damaged vision or brain trauma.