When to Treat a Sinus Infection (and When to Wait)

Not Everything is a Sinus Infection

When your face hurts, your head is pounding, and you can't breathe through your nose, it's easy to assume you have a sinus infection. But here's the thing: you might have inflamed sinuses without actually having an infection.

This is where terminology gets a little tricky. Sinusitis simply means inflammation of your sinuses. A sinus infection is when that inflammation is caused by viruses or bacteria actually infecting the sinus cavities. You can have sinusitis from other causes that feel just as miserable.

Upper respiratory infections, better known as colds, are the most common cause of non-infectious sinusitis. When you have a cold, the congestion and facial pressure can feel identical to a sinus infection. Your sinuses become inflamed and might feel full and achy, and you're probably dealing with plenty of mucus drainage. But that drainage is actually a normal part of your body fighting off the cold virus in your upper respiratory tract.

Allergies can also cause sinusitis without infection. If you're sensitive to pollen, dust, or other environmental triggers, you might experience the same sinus pressure, congestion, and headaches. The inflammation comes from your immune system overreacting to harmless substances rather than from an actual infection. That said, if allergies keep your sinuses blocked long enough, they can create an environment where a real sinus infection develops.

So what exactly happens during a sinus infection? Your sinuses are air-filled spaces in your skull, located around your nose and eyes. When viruses or bacteria infect these spaces, they fill with fluid and mucus instead of air. The result is that distinctive facial discomfort, the pressure that makes you feel like your head might explode, and pain that can radiate to your teeth or forehead.

What Causes Sinus Infections

Most sinus infections are caused by viruses. When you catch a cold or another upper respiratory infection, the virus causes inflammation in your nasal passages and sinuses. This inflammation leads to mucus buildup that blocks the normal drainage pathways in your sinuses. For most people, the infection clears up as the viral illness runs its course and drainage improves.

But sometimes, that blocked drainage creates an opportunity for bacteria to cause problems. When your sinuses can't drain properly, they become a warm, moist environment where bacteria that normally live harmlessly in your nose and throat can multiply out of control. This is why bacterial sinus infections can sometimes follow a cold. You start to feel better from your initial viral illness, and then your symptoms suddenly worsen or linger far longer than expected.

Bacterial sinus infections develop when your sinuses stay blocked, and those bacteria take hold. The key thing to understand is that not every sinus infection becomes bacterial. Most resolve on their own. Bacterial infections do have specific symptom patterns that help doctors distinguish them from viral infections.

When to Go to Urgent Care for a Suspected Sinus Infection

You should see an urgent care doctor or your primary care doctor if your symptoms suggest a bacterial infection. If your symptoms have lasted 10 days or longer without any improvement, it's time to get checked out. A high fever over 102°F combined with facial pain or pressure is another sign that bacteria might be involved. Pay attention to the pattern of your symptoms, too. If you start feeling better and then suddenly get worse again, doctors call this "double worsening," and it often signals a bacterial infection. Severe symptoms from the very start, like intense facial pain or swelling around your eyes, also warrant a visit.

Sometimes it's less about the specific symptoms and more about how they're affecting your life. If you can't sleep because of the pressure or pain, if you're missing work or unable to function normally, or if you've tried over-the-counter treatments without getting relief, come in to see an urgent care doctor. You know your body better than anyone. If something feels wrong or different from your usual colds, trust that instinct and get it checked.

You can likely manage at home if your symptoms have been present for less than a week to 10 days and you're seeing gradual improvement, even if it's slow. Mild to moderate symptoms that you can manage with over-the-counter treatments suggest your body is handling things on its own.

A few warning signs require immediate attention. Vision changes or swelling around your eyes, a severe headache combined with high fever and stiff neck, or confusion and altered mental state are all signs of rare but serious complications. If you experience any of these, go to the emergency room nearest you.

How Your Urgent Care Doctor Can Help with Sinus Infections

Getting an accurate diagnosis is the first step. When you visit an urgent care clinic with symptoms of a sinus infection, your provider will do a physical exam, checking for tenderness over your sinuses and looking inside your nose for inflammation or discharge. They'll want to hear about your symptom timeline and pattern, which helps distinguish between viral and bacterial infections.

Part of your urgent care visit will involve ruling out other causes, like allergies or structural issues that might be contributing to your symptoms. In some cases, especially if you have recurring problems, your doctor might order imaging to see what's actually happening inside your sinuses.

Once your urgent care doctor understands what's causing your symptoms, treatment gets tailored to your specific situation. This might mean antibiotics, steroids, supportive care, or a combination of approaches.

Antibiotics only work for bacterial infections. This is worth emphasizing because many people come in expecting antibiotics for any sinus problem. If your symptoms have lasted 10 days or more without improvement, if you have severe symptoms like high fever and intense facial pain, or if you experienced that "double worsening" pattern where you got better and then suddenly worse again, antibiotics are likely appropriate.

But if you have a viral sinus infection, which is the most common type, or if you're early in the course of your symptoms, antibiotics won't help. They won't speed your recovery if bacteria isn't the cause. Doctors don't automatically prescribe antibiotics because antibiotic resistance is a real concern, because they can cause side effects without providing benefit, and because your body can often clear even bacterial infections on its own.

Steroid shots reduce inflammation, not infection. Many people ask for steroid shots because they've heard they provide fast relief. And they can, but it's important to understand what they're actually doing. Steroids reduce swelling in your sinus passages, which helps your sinuses drain more effectively and relieves that intense pressure. They're helpful when severe inflammation is causing significant symptoms, when you need faster relief to function, or when combined with antibiotics for a bacterial infection. But steroids don't fight bacterial or viral infections, they won't prevent sinus infections from recurring, and they don't work as a standalone treatment for bacterial sinusitis.

Supportive care isn't "doing nothing." If your doctor recommends supportive care, there's a good reason for it. These are active treatments that help your body clear the infection naturally while reducing your symptoms. Nasal saline irrigation with a neti pot or saline spray helps flush out mucus and irritants. Staying well hydrated thins mucus so it drains more easily. Humidifiers keep your nasal passages moist. Decongestants provide symptom relief, though you should only use them for the short term. Pain relievers help with facial pain and headaches. This approach is the appropriate first-line treatment for viral sinusitis, and it genuinely helps you heal.

Beyond treating your current infection, your urgent care or primary care doctor can help you understand your specific triggers and develop strategies to prevent future infections. They'll create a follow-up plan, so you know what to expect and when to come back if things aren't improving. If you're dealing with chronic sinus issues, they can refer you to an ENT specialist for more specialized care.

Knowing when to seek care for a sinus infection is part of taking care of yourself. This isn't about toughing it out when you need help or rushing to the doctor unnecessarily. It's about making informed decisions based on what your body is telling you.

Your doctor is your partner in making the right call for your situation. At MedHelp, our providers are available through urgent care for walk-in visits when you need care quickly, or through primary care for ongoing, relationship-based care. Both options give you access to experienced providers who understand sinus infections and will recommend the treatment that's right for your specific symptoms.