Sinus Headache Without Congestion: How to Find Relief
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Medically reviewed by Brian H. Wetchler, DO
A sinus headache causes pain or pressure around the forehead, eyes, or cheeks. Associated congestion means the tissue lining the inner part of the nose is swollen from inflamed blood vessels. Mucus (snot) may also be present. Congestion nearly always accompanies a sinus headache, although this is not a hard-and-fast rule.
Allergies, infections, or nose/sinus structural abnormalities should be evaluated when a person has sinus headaches with or without congestion. Alternative diagnoses should also be considered, as sinus headaches can mimic headache disorders, namely migraine.
This article will review the possible causes and treatment of a sinus headache with or without congestion. It'll also briefly explore mimicking diagnoses like migraine.
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Reclassified Term
While still commonly used by patients and healthcare providers, the International Headache Society reclassified "sinus headache" as "a headache attributed to disorder of the nose or paranasal sinuses."
Sinus Headache Causes Without Congestion
Most sinus headaches are due to acute rhinosinusitis, a sudden and temporary inflammation of the nasal passages or sinuses (air-filled spaces in your skull that drain into your nose).
Rhinosinusitis can develop from allergies or infection, commonly with a virus and less commonly with bacteria or fungus.
While a sinus headache without congestion is uncommon in acute rhinosinusitis, it can occur with chronic rhinosinusitis.
Chronic rhinosinusitis describes nose/sinus inflammation lasting at least three months despite treatment. At least two symptoms must be present:
Facial pain, pressure, or fullness
Nasal congestion
Runny nose or mucus that drips down the back of the throat (postnasal drip)
Decreased or loss of sense of smell (anosmia)
Allergic rhinitis, also known as hay fever, is another condition that can cause sinus headaches without congestion in some individuals.
Allergic rhinitis is when a person's immune system overreacts to a substance (e.g., pollen or mold) that is usually harmless.
While typical symptoms include congestion and sneezing, often leading to a sinus headache, some people report dry nasal passages. An antihistamine, a common allergy medication, often worsens this dryness.
Although uncommon, specific anatomic nose variants may also cause a sinus headache without congestion.
For example, research suggests that a headache may be the presenting symptom of a deviated septum (when the wall between your nostrils is displaced to one side). The headache is believed to be caused by the displaced septum hitting tissue within the nose innervated by a sensory nerve.
Finally, environmental factors associated with a dry nose or sinuses may cause facial discomfort. Individuals often refer to that discomfort as a "sinus headache."
Exposure to these factors or agents includes:
Dry air
Cigarette smoke
Irritating chemicals (e.g., strong perfumes, cleaning products, or paint)
What Are Dry vs. Congested Sinuses?
"Dry sinuses" imply that the membranes inside the sinuses or nose lack moisture. "Congested sinuses" describe tissue swelling, often with mucus production.
Related: How to Treat a Dry Nose and Sinuses
When Could a Sinus Headache Be Something Else?
A sinus headache can resemble a primary headache disorder, namely a migraine. Primary headache disorders exist independently, whereas secondary headaches, like sinus headaches, are caused by an underlying health-related issue.
A migraine headache feels like a throbbing or pulsating sensation, usually on one side of the head. Migraine pain is often worsened by movement, and attacks can last four hours to several days.
Symptoms that can accompany a migraine headache include:
Nausea and/or vomiting
Neck pain and stiffness
A depressed or anxious mood
Trouble sleeping
Symptoms like congestion or discomfort near the sinuses may also occur with a migraine. This is due to trigeminal nerve irritation, the fifth cranial nerve with branches in the forehead, cheeks, and jaw.
Related: Symptoms and Stages of a Migraine Attack
Other primary headache disorders that can resemble sinus headaches include:
Tension-type headaches cause a tightening or pressure-like sensation around the head. Light or sound sensitivity (not both) and a loss of appetite can accompany the headache.
Cluster headaches cause excruciatingly severe pain centered in or around the eye or temple on one side of the head. Autonomic symptoms like a runny or stuffy nose or facial flushing are also present.
Related: Overview of Frontal Headaches
Relief for a Sinus Headache (With or Without Congestion)
Treatment of a sinus headache depends on the underlying cause.
Viral rhinosinusitis can generally be treated effectively at home with the following therapies:
An over-the-counter (OTC) painkiller like Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) like Advil or Motrin (ibuprofen)
A steroid nasal spray like Flonase (fluticasone propionate)
Facial steaming: May also be soothing, although the evidence backing this therapy up is inconsistent.
Bacterial and fungal rhinosinusitis symptoms can be treated with the same home therapies as viral rhinosinusitis. In addition, the underlying infection requires treatment with either an antibiotic or antifungal.
Precautions
Always talk with a healthcare provider before taking any OTC medication. Tylenol and NSAIDs may cause harm to people with certain medical conditions. Also, do not give aspirin (an NSAID) to children under 18 due to the risk of a serious disease called Reye's syndrome.
If allergic rhinitis is responsible, symptoms may be eased with a steroid nasal spray and avoiding allergy triggers—for example, keeping windows closed to keep pollen out of your home.
Learn More: How Allergies Are Treated
Medication or surgery may be helpful for structural abnormalities associated with a sinus headache. Specifically for a deviated septum, an operation called a septoplasty may be performed.
If you are experiencing nose/sinus dryness from moisture loss with your headaches, try the following:
Using a cool mist humidifier
Drinking plenty of water
Avoiding exposure to irritants like cigarette smoke
You can also talk with a healthcare provider about using a saline or hyaluronic acid nasal spray to help moisturize the inside of your nose and sinuses.
Learn More: Nasal Sprays Types and How to Use Them
The treatment plan is wholly different if a person's "sinus headaches" are migraines. For example, a healthcare provider may recommend an NSAID or a triptan for migraine headaches.
A triptan is a prescription migraine abortive drug targeting specific serotonin (a brain chemical) receptors. Triptans are available in several formulations, including pills, dissolvable tablets, nasal sprays, and injections.
Other migraine therapies include trigger avoidance (e.g., lack of sleep or hunger), napping in a dark, quiet room, and placing a frozen wrap on the neck at the start of the migraine.
Why Won’t My Sinus Headache Go Away?
A sinus headache that won't go away could be a sign of chronic rhinosinusitis, a structural nose/sinus problem, or an undiagnosed headache disorder like migraine.
These conditions require a diagnosis and a well-thought-out treatment plan from a healthcare provider, typically an ear, nose, and throat doctor (ENT) or a neurologist (healthcare provider specializing in nervous system conditions).
As such, seek medical attention if your sinus headache is severe, persistent, recurring, or associated with worrisome features like fever.
Also, see a healthcare provider if you are experiencing "sinus headaches" and have a history of cancer or a weakened immune system (e.g., diabetes).
When to Worry About Sinus Pressure Without Mucus
Sinus pressure without mucus requires evaluation by a healthcare provider for allergies, acute infection, irritant exposure, or headache—notably migraine.
Sinus pressure without mucus becomes concerning when persistent, despite treatment for common diagnoses like allergies or headaches. Seek medical attention in such a case or if the dryness is associated with symptoms like chronic nosebleeds, fever, neck stiffness, unusual fatigue, weight loss, or confusion.
Learn More: What Causes Fever and Headache Together and How It’s Treated
Summary
Most sinus headaches are associated with congestion (swollen membranes inside the nose and sinuses), but not always. Conditions or factors that affect the nose/sinuses include allergies, infections, irritants, and structural abnormalities, like a deviated septum. Sometimes, a "sinus headache" is actually a migraine or other type of headache.
Treating a sinus headache with or without congestion requires addressing the root cause. It may involve therapies like taking an OTC painkiller, using a cool mist humidifier, or, less commonly, antibiotics, prescription headache medication, or surgery.
