Sinus Migraines And Headaches: Diagnosis, Causes, And Treatments

What is a sinus headache?

Sinus headaches are a relatively rare type of headache that can produce pain and pressure in your face — particularly in the sinus area — due to sinusitis (a sinus disease/infection in your sinuses), nasal blockage, or allergies.

Some of the most common conditions associated with a sinus headache are:

• Acute sinusitis (lasts up to four weeks)

• Chronic sinusitis (can last years)

• Nasal polyposis (benign growths on the lining of your sinuses)

• Allergic rhinitis (allergies)

• Atrophic rhinitis (a condition affecting the inside of your nose)

How common are they?

Although these headaches are common with an infection, 90% of self-diagnosing cases aren't correct, as sinus headaches aren't nearly as common as many may think. In fact, some research has found that most of its participants with a diagnosis of sinus headache and sinusitis were actually cases of migraine.¹ ²

How do they differ from other types of headaches?

The major difference between sinus headaches and other headaches — tension, cluster, and migraine headaches — is not nasal symptoms. It's the root cause of the flare-up, typically associated with sinus congestion and infections. Another important difference is that once the infection is resolved, the headache will also begin to resolve. 

On the other hand, tension headaches are from tightened muscles in the neck and scalp. Migraines result from abnormal neurological changes in the brain, and a nerve pathway triggers cluster headaches in the part of the brain called the hypothalamus (which plays a role in your sleep/wake cycles).

Can they cause a migraine? How?

A sinus headache, in particular, cannot trigger a migraine. However, an association between allergic rhinitis (AR), another term for hay fever or allergies, and migraines have been observed in research.³

During an allergy reaction, there is a release of histamine, producing common side effects such as itching, irritation, inflammation, and blockage. This release of histamine — not the sinus headache, per se — has been linked to triggering migraine attacks. In fact, there has even been a focus on antihistamines as a form of treatment in past research since histamines are a potential 'provoking agent' for migraines.⁴

So, poorly controlled hay fever can lead to a sinus infection. A sinus infection could cause a sinus headache, which may lead to migraines. Therefore, the sinus headache itself is not the root cause of a migraine attack, but it can lead to one down the road.

Sinus headache vs. migraine

Although both types of headaches can produce similar symptoms (such as runny nose, watery eyes, and facial pain), they are not the same type. They have different underlying causes and triggers, different recommendations for treatment, and other key differences that separate their diagnosis.

Key differences

• Migraine headaches typically pulse and throb, while sinus headaches mostly cause sinus pressure.

• Migraines are typically confined to one side of your head, while sinus headaches can cause pain on both sides of your face.

• Pain can also occur anywhere on the head with migraine attacks versus confinement to the face.

• The nasal discharge discoloration and thickness often observed in sinus headaches don't occur in sinus migraines.

• When the sinus infections are resolved, the sinus headache often goes away.

• Unlike migraines, fevers are also more common with sinus headaches.

Is it a migraine or sinusitis?

Migraines are often confused with sinus headaches from sinusitis and other nasal infections, leading to many people with migraine attacks being diagnosed with sinusitis or self-diagnosed with sinus headaches.

A study in The Journal of Headache and Pain found that of the 130 migraine patients with a past diagnosis of sinusitis, 106 were misdiagnosed with the condition. Since their research was found to be in line with other studies, the data indicate that many patients complaining about sinus headaches may fit the criteria for migraine.²

Being able to tell the difference between the two conditions can make a substantial difference in the success of your treatment. 

How can you tell the difference?

The difference between migraine and sinusitis is in the additional signs and symptoms you may be experiencing. For instance, are you experiencing symptoms outside of a stuffy nose, runny nose, and other sinus symptoms? Particularly, are you experiencing sensitivities to lights or sounds, difficulty concentrating, or nausea?

According to a self-administering screening test for migraines called ID Migraine, which research has confirmed as a reliable method for screening, there are three questions to ask yourself to determine if you fit the criteria for migraines:⁵

1. Has a headache limited your activities for a day or more in the last three months?

2. Are you nauseated or sick to your stomach when you have a headache?

3. Does light bother you when you have a headache?

According to the test, if you can answer 'yes' to two or more of these questions, you will likely have migraines, not another condition like sinusitis. In fact, The American Migraine Foundation reports that if you can answer 'yes' to two of the questions, then the likelihood that you have migraines is 93%. If you can answer 'yes' to all three, the likelihood spikes to 98%.⁶

Can sinus pressure cause a migraine?

Just as a sinus headache is not the root cause of a migraine, neither is sinus pressure. Similarly, sinus pressure can be associated with migraines since it is part of the allergy response that releases histamine. Again, however, the histamine release from AR has been associated with migraines, not sinus pressure.

According to one study, the incidence of migraines in participants with AR was just over eight times higher than in the control group. So, while sinus pressure does not directly cause migraine, it can be somewhat associated.⁷

What are the symptoms of a sinus headache?

When experiencing a sinus headache, it is common to experience one or more of the following symptoms:

• Runny nose with purulent nasal discharge (greenish-yellow colored mucus)

• Stuffy nose

• Anosmia (inability to smell)

• Epistaxis (nosebleeds)

• Facial pain

• Brow pain

How can you treat a sinus headache?

These are some treatments that might be used to treat your sinus headaches depending on the cause of your headache:

• Saline flushes, a salty solution used to flush out nasal passages and relieve congestion and irritation

• Nasal steroids, an anti-inflammatory medicine you spray into your nose

• Saline spray is the saline solution you can spray in your nose to remove irritants and dilute mucous from the nasal passages

• Antihistamine spray can relieve sneezing, runny nose, and congestion by blocking the histamine response responsible for allergic reactions

• Over-the-counter antihistamines in the form of nasal sprays, eye drops, or oral medications, primarily used if your sinus headache is related to allergies

Consult your doctor if symptoms persist. Sinus infections can cause sinus headaches and may require additional treatment, such as antibiotics. 

How can you get relief?

Since you can't cure sinus headaches, treating your symptoms to reduce the severity is essential. Popular medications for relief often include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).

Tips to reduce the likelihood of having a sinus headache

There are a few ways you can reduce the likelihood of having a sinus headache, although none is a guaranteed prevention method.

First, you should keep your allergies under control by consulting your doctor about the best ways to prevent allergic reactions, particularly measures you can take around allergy season or other common exposures. 

Another preventative measure is avoiding contact with people you know to have a cold or respiratory infection. These are common illnesses that affect the sinus and can potentially cause you to have a sinus headache.

If you are a smoker, you should stop smoking. Otherwise, avoiding second-hand smoke and other air pollutants can be beneficial since they have been associated with chronic rhinosinusitis.⁸ ⁹

When to visit your doctor

Your primary care doctor should be informed about your entire history of sinus headaches. This includes everything from what you are allergic to or any symptoms you've experienced in the past to whether you have a history of sinusitis or any other infection that may cause a flare-up. 

Otherwise, additional visitations are recommended if any of the following apply:

• Your sinus headache symptoms worsen

• The headaches are causing major disruptions in your life or reducing your quality of life 

• If you suspect that you may not be suffering from sinus headaches but rather migraines

The lowdown

A sinus headache and a migraine are not the same. Migraines often have more symptoms beyond nasal symptoms and facial pain, such as nausea, sensory sensitivities, and throbbing pain. 

Whether you have an infection, allergies, or nasal blockages, a sinus headache is commonly associated with the condition. Although your sinus headache can turn into a migraine disease due to the release of histamines, there is no direct link that suggests a sinus headache can trigger a migraine.

Treatment for your condition will vary based on the cause of your sinus headaches and whether or not you want additional relief from headache symptoms. Either way, acute infections last less than a month, while chronic conditions can continue for years in severe cases. 

If you are concerned that your treatment isn't working and suspect you may be misdiagnosed, consult your doctor about a migraine headache diagnosis and your qualifications for the disorder. You should never make any changes to your treatment plan without discussing it with your healthcare professional.