Can allergies cause sinus pressure?

How allergies cause it

The sinus cavities are hollow air spaces in the skull.¹ They are located inside each cheekbone, behind the eyes, behind the bridge of the nose and in the forehead, and they have openings into the nose.¹ Allergies can cause swelling in these sinus cavities, which may block the openings and cause pressure to build up.¹

The sinuses have the same kind of tissue that lines the inside of the nose, and the same things that can cause swelling in the nose, such as allergies or an infection, can also affect the sinuses.⁶ With allergies, nasal and sinus passages become swollen, congested and inflamed in an attempt to flush out inhaled particles that trigger allergies.³ When the tissue inside the sinuses swells, mucus increases and disrupts normal drainage, and over time, air trapped inside swollen sinuses can create painful pressure inside the head.⁶

ACAAI lists sinus pressure among the common symptoms of hay fever, along with sneezing, congestion, coughing, itchy, watery eyes, an itchy nose, mouth and throat, and fatigue.² Pollen is a seasonal allergen, while molds, dust mites and pet dander can cause symptoms year-round.³ In spring the most common triggers are tree and grass pollen.² In fall, a common one is ragweed or other weed pollen, or outdoor mold.²

People with allergic rhinitis or asthma are more likely to have chronic sinusitis, because the airways are more likely to become inflamed.⁴ Sinusitis symptoms frequently develop after a cold or during times of severe or ongoing allergic rhinitis symptoms.⁴

Allergies or something else?

A bad cold is often mistaken for a sinus infection, and many symptoms are the same, including headache or facial pain, a runny nose and nasal congestion.³ Sinusitis itself is usually caused by the common cold, though other viruses, bacteria, fungi and allergies can also cause it.⁶ When a sinus infection results from blocked sinuses, symptoms may include facial pressure, particularly tenderness and swelling around your eyes, cheeks, nose and forehead.⁶

AAAAI describes how the three differ.⁵ Allergies bring a runny or stuffy nose, sneezing, wheezing, an itchy nose and watery or itchy eyes, and they last as long as the exposure lasts.⁵ A cold is similar to allergies but may also include a sore throat, fever and body aches, and should clear up within several days.⁵ Sinusitis brings a swollen, painful feeling around the forehead, eyes and cheeks; a stuffy nose with thick, colored mucus; a bad-tasting postnasal drip; bad breath; a sore throat; a cough; tiredness; and an occasional light fever.⁵ Hay fever doesn’t cause a fever.²

A 2021 systematic review concluded that migraine and tension-type headache are the most common causes of complaints in people who see a doctor for “sinus headache” and facial pain.⁸

When to see a doctor

CDC advises seeing a healthcare provider for severe symptoms, such as severe headache or facial pain.⁷ The same goes for symptoms that get worse after improving, symptoms lasting more than 10 days without getting better, a fever longer than 3 to 4 days, or multiple sinus infections in the past year.⁷

AAAAI says to make an appointment with your doctor right away if you have a fever, pain or swelling in the face or eye, redness on the cheek or around the eye, severe headaches, confusion or a stiff neck.⁴ ACAAI says symptoms such as a fever that won’t go away, a change in your eyesight, severe headaches and neck stiffness need immediate medical attention.³

Allergy testing performed by an allergist/immunologist can identify what allergic triggers might be behind chronic or recurring sinus infections.⁴