Sinuses are among those parts of the body that we tend to ignore until something goes wrong. These hollow cavities, lined with a mucous membrane, usually sit quietly behind the nose and forehead. But infection or allergies can cause the membranes to become inflamed and irritated, resulting in pain and pressure.

That distinction—between actual pain versus a sensation of pressure—is important, says Dr. John Schneider, an ear, nose and throat specialist with Washington University Physicians. “ ‘Sinus pain,’ in general, is somewhat of a misnomer,” he says. “Most people I see who have ‘sinus pain’ or facial pain usually have something other than sinusitis.”

Pain in the cheeks may be due to inflammation of the tissues surrounding the temporo-mandibular joint (TMJ), which connects the jaw to the side of the head. Migraine headaches also may present with facial pain, sometimes mistaken for sinus pain, Schneider says.

“People who have sinus disorders, like chronic sinusitis (inflammation of sinus membranes), usually suffer from pressure more than pain,” he says. And when asked, many people complaining of ‘sinus pain’ will clarify that they are actually experiencing pressure, presenting as a dull ache rather than a sharp or stabbing sensation. Because the distinction can be hard to make, Schneider recommends consulting your primary-care physician to determine the true cause of discomfort. Referral to a specialist may be needed for more advanced testing and diagnosis.

When sinus infections, allergies or anatomical abnormalities do cause pain or pressure, many people seek over-the-counter remedies, such as antihistamines, decongestants, neti pots and nasal sprays. “You should seek medical care if you have tried over-the-counter medications and are not experiencing any improvement in symptoms or if your symptoms last more than 10 days,” advises Dr. Kim Waterhouse, a specialist in allergies and immunology with SSM Medical Group.

“The medical treatments available will depend on the underlying cause of your symptoms,” Waterhouse adds. “If your symptoms are caused by a common cold, they will resolve within seven to 10 days without further medical treatment. If your symptoms are secondary to a bacterial infection, you may need an antibiotic. If you have allergic rhinitis causing your symptoms, there are a variety of prescription nasal sprays that may improve your symptoms or you may benefit from allergy shots. If there is an anatomical abnormality of your sinuses, you may require sinus surgery.”

Schneider adds that further assessments by neurologists are often needed to confirm and treat a diagnosis of migraine. People found to be experiencing pain due to TMJ issues may benefit from physical therapy and facial massage to decrease chronic inflammation.

“Finding the root cause of facial pain can be challenging,” he says. “It’s a good idea to let your doctor take a look and see what’s really going on.”

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