How can I tell if I have a migraine or a sinus headache?

Sinus headache usually refers to pain that is felt over the forehead and cheeks that is associated with nasal congestion or runny nose. However, if the pain is the primary complaint, most often this type of headache is actually a migraine. Only in the setting of an active infection where the primary symptoms are fever, cough and bloody thick nasal discharge can headache be attributed to sinus infection. Chronic sinusitis is never a cause of headaches. There is a widespread misconception that pain over the forehead and cheeks is related to the sinuses. Migraine not only can give pain over the forehead and face but can cause nasal stuffiness, eye tearing and runny nose. People who have frequent headaches involving the front of their head/face should not only be evaluated by an ENT but should also see a neurologist about the possibility of migraine.
There is a common misconception that chronic sinus issues cause headache. The truth is, unless you have a fever, pressure in the sinuses, and discolored nasal discharge, your sinuses are probably not causing your headache. If you have the aforementioned symptoms you are likely suffering from acute sinusitis and require antibiotic treatment.
However, if you have a recurrent runny nose, watery eyes, and facial pain/pressure along with headache without fever or discolored discharge, you likely suffer from migraines. The pain pathway that leads to migraine also activates something called the Parasympathetic nervous system. This activation leads to a runny nose and eyes, which is what leads many people to believe they have a sinus infection. Always check with your doctor if you are not sure. But, if you have this type of headache repeatedly, you may suffer from migraines.

Many people confuse a sinus headache with a migraine because pain and pressure in the sinuses, nasal congestion, and watery eyes often occur with migraine. To find out if your headache is sinus or migraine, ask yourself these questions:

In addition to my sinus symptoms, do I have?

  • Moderate-to-severe headache
  • Nausea
  • Sensitivity to light

If you answer "yes" to two or three of these questions, then most likely you have migraine with sinus symptoms. A true sinus headache is rare and usually occurs due to sinus infection. In a sinus infection, you would also likely have a fever and thick nasal secretions that are yellow, green, or blood-tinged. A sinus headache should go away with treatment of the sinus infection.

The answer is based on source information from the National Women's Health Information Center.

More than 4 out of 5 people who think they have a sinus headache, with symptoms like pain in the head, stuffy nose and watery eyes, may actually have a migraine headache. Sinus headaches and migraine headaches can have some common symptoms.

Migraine headaches are frequent, severe headaches of unknown origin that last between 4 and 72 hours and are accompanied by visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face.

Sinus headaches are infrequent, mild to moderate headaches associated with acute infection, chronic inflammation of nasal passages and sinuses or persistent allergic rhinosinusitis. The common symptoms include pain localized to the head, particularly the forehead, itchy or watery eyes and pain associated with head movement. Often, there are some distinguishing features of migraine headaches that are not seen with sinus headaches, including nausea or vomiting, sensitivity to light or sound and severe throbbing pain confined to one side of the head. Sinus headaches are usually caused by an infection and inflammation of the nasal passages and nasal sinuses, and lead to head congestion
that causes pain and pressure in the forehead and/or behind the cheekbones, the approximate location of the maxillary and frontal sinuses. A patient suffering from a sinus infection tends to say that constitutional symptoms like fever and chills, facial pressure and pain, swollen lymph nodes and copious mucopurulent nasal discharge, with or without post-nasal drip, tend to precede any headache symptoms. In short, the patient reports they were sick first and later developed the headache.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.