I have had sinus pressure for years, but

Tonight, keep Wednesday's appointment as the door, and start a one-line diary — that log is the one thing only you can produce before you get there, and it is what decides whether this gets looked at as a headache pattern rather than a sinus problem. I can't tell you from a message whether this is migraine, and a clear ENT exam doesn't settle that question either — but the pattern is readable, and you're the one who can record it.

1) What you've tried, and the better next move

You've been using a decongestant spray every day. That is the single most useful thing to raise on Wednesday, because daily use is exactly the kind of detail that changes the plan — bring the bottle with you, and check the leaflet or ask a pharmacist what length of use it states for that product. Do not start, stop or change it on your own; that call belongs to your prescriber or pharmacist.

For the diary, one line per day, takes about a minute: time of day it started or was worst, one side or both / face or head, throbbing vs steady pressure, any nausea or light sensitivity, whether bending forward or lying down made it worse, hours of sleep, whether you ate, and what you did or took that day. Over a week that pattern does more than another examination will.

Two things worth knowing as you write it: migraine pain is usually throbbing, often one-sided, worse when you move, with nausea and sensitivity to light or sound (NHS, nhs.uk/conditions/migraine, checked 7 Oct 2026). Sinus-type pressure tends to sit in the face, forehead or teeth, and gets worse when you bend forward or lie down. Plenty of people sit in the overlap — which is exactly why the diary, not guessing tonight, is what moves things forward.

Tonight, under 25 minutes total: saline rinse or a shower if either one usually feels better — that is comfort, not treatment. A glass of water. Lights low, phone down if the pressure is worse in the evening. Then the diary line, and lights out earlier than the school run demands, because broken sleep is on the migraine trigger list and you are running on fumes.

What success looks like in 24 hours: not pain-free — a diary you can actually keep, a clearer sense of whether this is steady background pressure or comes in defined attacks, one less unknown on Wednesday, and a night where you were not up thinking about it. That is a real gain even if the pressure stays.

2) Constraints and avoid list

• Don't add a new painkiller, combination cold product, or anyone else's tablet on top of daily nasal spray. Overlapping ingredients and daily use are things only a clinician can sort, and frequent painkiller use is itself a recognised cause of more headaches.
• Don't buy prescription medicines online or mix in unlabelled powders or herbal sprays. No pharmacist has seen them, and nobody can check them against what you already take.
• Don't keep the daily spray running indefinitely while you wait — not because I'm telling you to stop, but because "how long should this go on, and what should replace it?" belongs on Wednesday's list, in writing.
• No home neti-pot improvisation with untreated water, and nothing poured into the nose that isn't a product designed for it.
• Keep the pressure diary separate from the kids' week. Ten seconds at the kettle beats ten minutes of reconstructing memory on Wednesday night.

3) Red flags — when to stop home care and get help

Call your local emergency number now if any of these happen:

• A headache that comes on suddenly and reaches full force within seconds, or is the worst you have ever had. Migraine does not arrive like that, even if you get migraines.
• New weakness or numbness on one side, trouble speaking or remembering things, loss of vision, blurred or double vision that is new.
• Feeling drowsy or confused, a fit, a very high temperature with a headache and a stiff neck.
• A red painful eye with rainbow rings around lights.
• A headache that wakes you from sleep, or is there on waking with vomiting, or is much worse on coughing or bending.

If none of those, this stays a B-level question for Wednesday rather than an emergency — but ask to be seen if attacks become more frequent, more severe, longer, or harder to control, and say plainly at the appointment: "I've had this for years, my sinuses are clear, and I've been using a decongestant spray daily."

The four questions worth leaving the room with answers to: is this a headache disorder rather than a sinus problem — and if so, which type? Given the daily spray, is my congestion partly caused by the treatment? What should I use instead, and for how long? What specific change should bring me back before Wednesday?

One thing that would sharpen Wednesday: is this mostly a steady background pressure you carry most days, or distinct attacks that build and lift, with nausea or light sensitivity? Everything above holds either way — that answer just changes which of the two conversations you lead with.