Is That Migraine Pain or Your Sinuses?

What's the difference between a migraine and a sinus headache? For a surprising number of headache sufferers, it's hard to tell them apart. It's even worse when patients with migraine and sinus headaches receive the wrong medical treatment. Here's how to tell them apart:

The Department of Health and Human Services Office on Women's Health says true sinus headaches are actually quite rare and are usually associated with sinus infections, which are also called sinusitis. Sinusitis involves inflammation and infection of the sinus tissues. Symptoms of sinusitis include:

  • Pain or pressure in or above the cheekbones, behind the eyes and/or in the temple area
  • Nasal congestion
  • Thick, yellow, green or blood tinged nasal discharge
  • Decreased sense of smell
  • Cough or chest congestion
  • Fever
  • Bad Breath
  • Body aches
  • Dental pain
  • Fatigue

Migraine symptoms vary greatly from person to person, but symptoms can include:

  • Moderate to severe headache
  • Intense throbbing pain on one or both sides of the head
  • Pain in the temple and/or behind the eye, ear or cheekbones
  • Nausea and vomiting
  • Sensitivity to light and sound
  • Visual changes like flashing or shimmering lights, seeing spots or temporary loss of vision
  • Clear nasal discharge
  • Watery eyes

How to Tell Them Apart

DHHS says, "To find out if your headache is sinus or migraine, ask yourself if in addition to sinus symptoms, you have:

  1. Moderate-to-severe headache
  2. Nausea
  3. Sensitivity to light

If you answer, "yes" to two or three of these questions, you probably have migraine with sinus symptoms. If your symptoms occur regularly, frequently or are associated with certain triggers like specific foods, fatigue, hormonal or weather changes, you can almost count on your symptoms being migraine, not sinus related. 

How Does Treatment Differ for Sinusitis and Migraine?

Sinus infection is usually treated with antibiotics. If sinusitis occurs often or comes back after antibiotic treatment, your doctor might order diagnostic tests like x-ray, CT scan, or allergy testing to find out what's causing your sinus problems. He might also treat your sinusitis with antihistamines and/or medications to relieve congestion and reduce inflammation. Some doctors recommend nasal irrigation with a diluted saline solution to remove allergens and reduce inflammation. 

Migraine treatments center on prevention measures including identifying and avoiding triggers that cause headache. Medications are often prescribed to treat the pain, nausea and other symptoms and address underlying medical problems that might be causing migraines. 

Overuse of antibiotics is a growing problem in the medical community because it leads to development of bacteria that are resistant to standard medications. Conversely, if your doctor is treating your sinus infection like a migraine, you might be living with a chronic infection that could impact your overall health.   

If you suffer with frequent or chronic headache, talk to your doctor about how to identify the cause and find the best treatments for you.  


Department of Health and Human Services Office on Women's Health

Migraine Fact Sheet