Pressure across the cheeks and forehead, a blocked nose, and the feeling that your face is slightly too full. It is miserable, it is common, and most of what gets prescribed for it is unnecessary.
Two things on this page are worth the read: the cheapest effective measure, and the possibility that this is not your sinuses at all.
Most of it is viral
Which is not a dismissal, and does not mean it is trivial. It is simply the reason the genuinely useful measures are the ones below rather than a trip for a prescription.
Acute sinus symptoms usually follow a cold, and the great majority are viral. They resolve without antibiotics, which is why prescribing has moved away from treating them by default.
| Pattern | Suggests | What to do |
|---|---|---|
| Follows a cold, improving by day 7–10 | Viral, resolving | Comfort measures |
| Ten days, no improvement at all | Possible bacterial | See a doctor |
| Improved, then clearly worse again | Possible bacterial | See a doctor |
| Severe with high fever from the start | Possible bacterial | See a doctor |
| Twelve weeks or more of symptoms | Chronic rhinosinusitis | Ask for an ENT referral |
| Swelling around an eye, or vision change | Serious complication | Urgent care |
Why antibiotics are not the default any more
This changed within most people’s adult lives, so the expectation often lags behind the practice.
The colour of nasal discharge, which used to be treated as evidence of bacterial infection, turns out to be a poor guide — it reflects the immune response rather than what is causing it. Green mucus is not proof of anything requiring an antibiotic.
What guides the decision now is the pattern over time: duration without improvement, severity with fever, or clear worsening after an initial improvement. That is what the table above sets out.
The cheapest thing that works
Saline nasal irrigation — rinsing the nasal passages with salt water — is well supported, costs almost nothing, and is skipped by nearly everyone.
It works mechanically rather than pharmacologically: it clears mucus, allergens and irritants out of the nose. That is also why it helps across several different conditions rather than just one.
One safety point that matters. Use distilled water, or water that has been boiled and cooled. Not straight from the tap. The risk from untreated tap water in the nose is very small but serious, and it is entirely avoidable.
The American Academy of Otolaryngology publishes patient guidance on sinus conditions and on doing this properly.
It might be migraine
This is the second useful thing on the page, and it surprises people.
A substantial proportion of people who believe they get sinus headaches meet the criteria for migraine when assessed. Migraine commonly produces facial pressure, nasal congestion and watery eyes, because the nerve involved supplies that whole region.
It matters because the treatments differ entirely. If your “sinus headaches” come without a cold, recur predictably, worsen with movement, or come with light sensitivity or nausea, read acupuncture for migraines and tension headaches and consider raising migraine with your doctor.
What else helps
- Intranasal steroid sprays, which are effective and often used for too short a time to work — they take days to weeks.
- Simple analgesia for the pressure and discomfort.
- Steam and humidity, which are comfort measures rather than treatments. Pleasant, weakly supported.
- Decongestant sprays for no more than a few days. Longer and you get rebound congestion, which feels exactly like the problem returning.
- Treating the allergy if there is one — see acupuncture for seasonal allergies, where the evidence is genuinely better.
Sinus or migraine? A closer look
Since the distinction changes the treatment entirely, it is worth setting the two side by side.
| Feature | Sinus infection | Migraine |
|---|---|---|
| Starts with | A cold, usually | Nothing in particular |
| Discharge | Thick, coloured | Clear, if any |
| Fever | Sometimes | No |
| Sense of smell | Reduced or absent | Usually normal, sometimes heightened |
| Light and noise | Not particularly | Often intolerable |
| Pattern | One episode, then better | Recurs, often predictably |
| Movement | Bending forward hurts | Routine activity makes it worse |
Where acupuncture fits
Thinly, for sinusitis itself. There is not a body of trial evidence supporting acupuncture for acute or chronic sinus infection, and we are not going to borrow the allergic rhinitis evidence and pretend it transfers.
Where it has more of a case is allergic rhinitis, which appears in mainstream ENT clinical guidance as a reasonable option, and which is a different condition with its own article.
When to see a doctor
See a doctor for symptoms lasting more than ten days without any improvement, for symptoms that improve then clearly worsen, for high fever, or for symptoms lasting twelve weeks or more.
Seek urgent care for swelling or redness around an eye, changes in vision, a severe headache with confusion or neck stiffness, or facial numbness.
Booking a session in Beverly
Acupuncture is $75 a session, and everything is on our rates page. If seasonal allergy is the underlying driver, say so when you book — it changes the timing of what we would suggest.
Browse all our articles or get in touch.
Frequently asked questions
Do I need antibiotics for a sinus infection?
Usually not. Most acute sinus infections are viral and settle on their own. Antibiotics are considered when symptoms last beyond about ten days without improving, when they are severe with a high fever, or when you improve and then clearly get worse again.
Does saline rinsing actually help?
Yes, and it is one of the better supported and least used measures available. It clears mucus and irritants directly. It costs very little and has no meaningful downside when done correctly.
Is it safe to use tap water for nasal rinsing?
No. Use distilled or previously boiled and cooled water. Untreated tap water carries a very small but genuinely serious risk of infection when introduced into the nose, and this is the one safety point worth taking seriously.
Could my sinus headache actually be migraine?
Quite possibly. Studies of people who self-diagnose sinus headache find that a large share meet the criteria for migraine instead. Facial pressure, nasal congestion and watery eyes all occur in migraine, which is why the confusion is so common.
Does acupuncture help sinus problems?
The evidence is thin for sinusitis specifically. It is somewhat better for allergic rhinitis, which appears in mainstream ENT guidance, and that is a different condition covered separately.
This article is general information, not medical advice. Acupuncture is intended to work alongside the care of your doctor, not to replace it. Please speak to a clinician about any new, severe or changing symptom.