Introduction

What is nasal congestion?

Nasal congestion, also known as a blocked nose or having a stuffy nose, occurs when the tissues and blood vessels inside your nose swell with too much fluid, causing your nasal passages to become blocked. 

What is a sinus headache?

A sinus headache is described as having pain and pressure in your sinuses, around your eyes, eyebrows, cheeks and forehead. You may now be asking: what causes a sinus headache? Typically, sinus headaches are caused when the blood vessels in your nose and sinuses (air-filled spaces in your forehead, cheeks and nose) start to swell and become inflamed. This inflammation in your nose and sinuses can result in a feeling of pressure, resulting in a sinus headache.

Sadly, sinus headaches are often misdiagnosed by medical professionals and are eventually found to be chronic migraines. The symptoms of migraine headaches and sinus headaches heavily overlap, which can result in the two types of headaches being mistaken for one another. Studies have found that 90% of those experiencing sinus headache symptoms are actually having a migraine headache, which is a substantial number. As these headaches have different treatment options, misdiagnosis is an issue. It is being addressed in the medical field to ensure the correct diagnosis is reached, and effective treatment is deployed as soon as possible. This ensures the smoothest route of recovery is reached for you, the patient.¹

Causes of nasal congestion

Common causes

Allergies

Allergies can result in nasal congestion by causing swelling in your mucosal membranes (the inner lining of your nasal passages). The swelling inside of your nose blocks your nasal passages. Common allergens that can cause this include the following:

• Pollen
• Mould
• Dust
• Dust mites
• Contact with flakes of animal skin

Infections 

Certain infections can cause nasal congestion, including the following:

• Common cold
• Flu
• Sinusitis

Viruses that can cause these infections enter your body via your nasal passages when you are breathing, and start attacking the mucosal membranes in your nose, resulting in the swelling of the nasal passages.² 

Environmental factors

The air you are exposed to can result in nasal congestion. Inhaling both dry and cold air can irritate the inner lining of your nasal passages. In turn, this causes inflammation and swelling, which you perceive as having a blocked nose. 

Other causes

Structural issues of the nose

Certain structural issues with your nose can also result in nasal congestion. For example, if you have a deviated septum. A deviated septum is when the cartilage that separates your two nostrils is not directly on the midline of the nostrils. As a result, the inner lining of your nostrils can become inflamed and start to swell, causing you to experience nasal congestion.

Nasal polyps are another possible cause of nasal congestion. In this condition, soft and painless growths occur in your nostrils. As the polyps grow inside your nostrils you may experience having a blocked nose. 

Medications

Certain medications, such as ACE inhibitors, used to treat high blood pressure, can cause nasal congestion as a side effect. 

Additionally, if you have a blocked nose, you may start to use nasal decongestants to unblock your nose and relieve yourself of your symptoms. However, it is advised that decongestants should be used for a maximum of 7 days at a time. Prolonged use of decongestants can cause the inner lining of your nostrils to become irritated and this can start to make them swell, making your nasal congestion worse. 

Causes of sinus headaches

Common causes 

Respiratory infection

An upper respiratory infection, caused by a virus, can cause sinusitis. Sinusitis is an infection of the sinuses, which can result in you experiencing a sinus headache (pain and pressure around your eyes, eyebrows, nose and cheeks).³

Allergies

Similar to how allergies can cause nasal congestion, allergies can also cause sinus headaches. Allergens such as pollen, pet dander and mould can irritate your sinuses, causing your immune system to respond by causing swelling in the sinuses. This swelling causes a sinus headache.

Nasal polyps

As well as being a cause of nasal congestion, nasal polyps can cause swelling in the sinuses, as well as the inside of the nasal passages. Swelling in the sinuses can cause sinusitis, which in turn can cause a sinus headache. 

Deviated septum

Having a deviated septum can result in your sinuses not draining properly, which can cause them to become infected. In turn, the infection (sinusitis) can result in sinus headaches.

Differentiating sinus headaches from other types of headaches

Location and nature of pain

The pain from a sinus headache is usually in selective areas of the face, rather than general pain and pressure in the whole of your head/face. The pain is usually accompanied by pressure, typically behind your eyebrows, cheeks, sinuses and your forehead. 

Presence of unique symptoms

Whilst sinus headaches are commonly misdiagnosed by medical professionals, they do have unique symptoms that can help you to recognise your headache as a sinus. For example, sinus headaches are typically accompanied by nasal congestion/having a blocked nose. Additionally, sinus headaches cause pain in the upper teeth or on one side of the cheek, which is something that migraines do not. In addition, following the causes of sinus headaches, they can occur after an upper respiratory infection, which is something to keep a lookout for. 

Symptoms Nasal congestion

The symptoms of nasal congestion are:

• Having a runny or stuffy nose
• Nosebleeds
• Having a reduced sense of smell or taste
• Sneezing
• Having a sore throat
• Coughing
• Having ear pain
• Having bad breath
• Eyes watering
• Feeling fatigued
• Fever
• Having an itchy nose, mouth or throat
• Experiencing mild body aches
• Pain in your upper jaw
• Having a crust inside the nose

Sinus headaches

The symptoms of sinus headaches are as follows:

• Aching pain in your upper teeth
• Having a runny or stuffy nose
• Feeling pressure and pain behind your cheeks, eyebrows and/or forehead
• Pain experienced is worsened if you are lying down or bending forward
• Feeling fatigued
• Having a fever
• Having a weakened sense of smell/not being able to smell

Diagnostic methods

Physical examination 

A physical examination to diagnose nasal congestion and to see if there is an infection of the sinuses (which can lead to a sinus headache) is the nasal endoscopy.⁴ A nasal endoscopy involves a medical professional inserting an endoscope in your nose. An endoscope is a small, thin and flexible tube, which has a camera on the tip to visualise the inside of your nose. This allows a medical professional to see if there is any blockage in your nose or sinuses. 

Imaging tests 

You may have to have an imaging scan, such as a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan.⁴ These scans allow medical professionals to see inside your nose and sinuses in great detail, to see if there is an infection, or if there is a blockage, such as those caused by nasal polyps. 

Allergy testing

If it is suspected that your nasal congestion and/or sinus headache are caused by an allergy, you can have a skin prick test to see if you have an allergy.⁴ During this test you are pricked with a small amount of the suspected allergen to see how your skin reacts in response to the allergen. 

Treatment options

Over-the-counter treatments

Decongestants

Decongestants can be used to relieve your symptoms of nasal congestion and sinusitis. Decongestants work by reducing the swelling of the blood vessels inside your nostrils, helping to open up your nasal passages and helping you to breathe with ease. 

Steroid nasal sprays

It may be recommended for you to take steroid nasal sprays to treat nasal congestion, They can reduce the swelling inside your nose and can also treat nasal polyps if they are small. 

Prescription medications

Antihistamines for allergies

You may be prescribed antihistamines for nasal congestion. Antihistamines prevent the action of histamine in your body, which is responsible for nasal congestion.

Surgery

Surgery can be an option to consider if you have a deviated septum or nasal polyps.⁴ 

Home remedies and lifestyle changes

Steam inhalation

Steam inhalation is a recommended home ready to aid in relieving both sinus and nasal congestion. It is recommended that steam inhalation should be done for approximately 10 minutes at a time a few times a day, for optimal results. 

Hydration

Ensure that you are drinking plenty of fluids if you have nasal congestion, as this makes your mucus thin, allowing it to drain more easily and ease congestion. 

Summary

• Nasal congestion occurs when the tissues and blood vessels in your nose swell with too much fluid, causing you to have a blocked nose
• A sinus headache involves experiencing pain and pressure around your eyes, brows, sinuses, cheeks and forehead
• A sinus headache can be easily misdiagnosed as a migraine
• Allergies and structural issues of the nose can cause both a sinus headache and nasal congestion
• A sinus headache can be caused by an upper respiratory infection
• Some medications and infections can cause nasal congestion
• Nasal congestion and sinus headaches can be relieved with decongestants 
• Nasal congestion can be relieved with nasal sprays, antihistamines, steam inhalation and hydration too
• Surgery is an option to consider for some causes of nasal congestion and sinus headache, such as nasal polyps and a deviated septum