Sinus Headache vs. Migraine: How to Tell the Difference
The symptoms of a migraine attack can overlap with those of a sinus headache, but the causes of and treatment for each are different.
If you've ever self-diagnosed a sinus headache, there's about a 9 in 10 chance you've actually had a migraine attack. Both migraine and sinus headaches can cause sinus-related symptoms, so it's easy to confuse them.
Each type of head pain has distinct causes, however, and can affect different parts of your head. The quickest route to relief is correctly identifying what's causing the pain so you can get effective treatment.
“Sinus headache” is technically a misnomer, says Megan Donnelly, DO, the head of the comprehensive headache center and women's neurology at Novant Health in Charlotte, North Carolina. “There's no International Classification of Headache Disorders code for it.”
Indeed, there's no single code for “sinus headache” in the ICHD, a guide that healthcare practitioners use when they record a diagnosis in your medical records. Instead, there are multiple codes for more specific diagnoses, such as “headache attributed to disorder of the nose or paranasal sinuses" and “headache attributed to acute rhinosinusitis,” among others.
What we call a “sinus headache” is actually pain as a symptom of a sinus condition. “Sinus headaches are typically a sign of a sinus infection or chronic nasal inflammation,” says Geoffrey B. Trenkle, DO, the CEO and founder of the Los Angeles Center for Ear, Nose, Throat and Allergy. But head pain given a “sinus headache” designation is often a misdiagnosis of migraine.
Meanwhile, migraine is its own diagnosis with a variety of triggers. Contrary to what many believe, migraine is more common than sinus headaches.
Each type of head pain has its own symptoms, but there's some overlap, since they involve some of the same nerve pathways. Treatment is different, too — sinus headache treatment addresses specific underlying sinus issues, including inflammation, while treating migraine can involve medications that target different underlying causes.
You might mistake a migraine attack for a sinus headache because the pain may affect the bridge of your nose and forehead, two spots we associate with the sinuses.
Many other symptoms of migraine and sinus headache overlap as well, with very few distinctions, making it difficult to know for sure which you have without seeking a headache specialist's care. This chart illustrates just how much overlap exists.
Migraine affects the autonomic nervous system, which regulates involuntary bodily functions like blood pressure and heart rate, so it can also cause what experts call autonomic symptoms. Some of the sinus symptoms that may accompany a migraine attack, such as watery eyes and nasal congestion, fall under this umbrella.
Do Sinus Headaches Cause an Aura?
Auras occur in about 25 to 30 percent of people with migraine.
They tend to last for an hour or less before a migraine attack and most commonly involve vision changes including spots, flashing lights, or squiggly lines or patterns. Aura can also cause numbness, tingling, or speech and language difficulties.
Auras are a feature of migraine attacks — never sinus headaches — although most people with migraine do not experience aura. It’s common to mistake migraine for a sinus headache when migraine appears without aura.
The true cause of migraine is still being studied, but many factors — like inflammation, hormones, neurological diseases, and genetics — may contribute to its development.
Migraine also involves a variety of risk factors and related conditions. You're more likely to experience migraine if you're female, middle-aged, or you smoke. Sleep disorders, coronary artery disease, and autoimmune conditions are also risk factors.
Meanwhile, a bacterial or viral illness that results in a sinus infection is a common cause of sinus headaches. The following factors could also cause chronic sinusitis, or inflamed sinuses, which often induce headaches involving facial pain and pressure:
Deviated septum
Nasal polyps
Allergies
Asthma
It's not uncommon for these risk factors to overlap. For instance, deviated septum is a known migraine comorbidity, but it can also be a risk factor for other types of head pain like sinus headaches.
Can Allergies and Infected Sinuses Trigger Migraine?
Ongoing sinus inflammation or congestion could trigger migraine for people with chronic sinusitis, says Dr. Trenkle. He adds that allergies or mild sinus inflammation that cause congestion could also be triggers.
Up to 37 percent of people with allergies may also have migraine. And evidence suggests that when certain foods trigger migraine, it could be due to a food allergy.Asthma commonly co-occurs with migraine as well.
Can You Have Migraine and Sinus Headache at the Same Time?
It's possible to experience both sinus-related headaches and migraine, especially if you have chronic sinus disease and a history of migraine attacks, says Trenkle.
In a study of 213 people with chronic sinusitis, 36.2 percent also had migraine.
No specific diagnosis covers this combination, but doctors can address both when necessary. Trenkle says his practice often helps people dealing with both conditions come up with personalized treatment plans to manage sinus inflammation while addressing migraine.
Migraine can cause sinus symptoms, and sinus conditions can trigger migraine, clouding the root cause. In a Polish migraine study, 20.3 percent of people who had migraine without aura got the wrong diagnosis.
Trenkle says he often sees patients who received a sinus headache diagnosis even though migraine was the root issue. Donnelly says that she gets a significant amount of referrals for migraine treatment from ear, nose, and throat specialists.
Doctors can use nasal endoscopy, a CT scan, or allergy testing to screen for sinus issues, says Trenkle. Migraine is a clinical diagnosis, so imaging isn't involved, says Donnelly. Your doctor might ask about symptoms specific to migraine to diagnose it instead.
Before a screening appointment, experts say it's a good idea to be ready to report on any recent infections, vision or language changes that occur before headaches, and allergies or other medical diagnoses you might have.
What Other Headache Types Do People Confuse for Sinus Headaches?
Tension headaches involve a mild to moderate sensation of pain, pressure, or aching wrapping around your head. The symptoms can feel similar to sinus head pain, complicating diagnosis.
Each condition has a different treatment approach, so it's important to get the correct diagnosis first.
Migraine
Medication can be a significant part of migraine treatment.
Trenkle says sinus headache treatment depends on the root cause, so approaches vary from over-the-counter medicines to interventions like surgery (seeking a second opinion from a headache specialist is advised if surgery is recommended). If a sinus infection is the root cause, for example, antibiotics might help you get rid of the headache by fighting the infection.
“Chronic sinusitis may require consistent use of nasal steroids, allergy treatments such as antihistamines or immunotherapy, and sinus surgery for cases that don't improve with other treatments,” Trenkle adds.
Over-the-counter decongestants and pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) could also help.
Migraine can cause sinus symptoms like facial pain, runny nose, and watery eyes, and is more common than sinus headaches.
Light and sound sensitivity only accompany migraine attacks, while yellow or green snot and fever are unique to sinusitis.
If you're not sure what's causing your head pain, reach out to a headache specialist physician who can help with screening, diagnosis, and treatment plans.
