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Migraine vs Sinus Headache

  • Writer: David S. Klein, MD FACA FACPM
    David S. Klein, MD FACA FACPM
  • 5 minutes ago
  • 5 min read

Migraine vs. Sinus Headache


Why the Difference Matters—and How to Tell Them Apart


Migraines and sinus headaches can strike anytime, anywhere—and both can be painful enough to derail your day. Because their symptoms often overlap, many people assume they’re having a “sinus headache” when the true cause is migraine.

Understanding the difference matters. The correct diagnosis leads to the correct treatment—and faster, more reliable relief.


What Is a Migraine?


A migraine is a neurological disorder, not a sinus problem. It is characterized by moderate to severe head pain that is often throbbing or pulsating and commonly affects one side of the head.

Migraine attacks are frequently accompanied by additional symptoms that reflect involvement of the nervous system.


Common Migraine Features


  • Throbbing or pulsing head pain (often one-sided)

  • Nausea and/or vomiting

  • Sensitivity to light (photophobia)

  • Sensitivity to sound (phonophobia)

  • Worsening pain with routine physical activity

  • Visual or sensory aura in some individuals

Importantly, nasal symptoms can also occur during migraine, including:

  • Runny or stuffy nose

  • Watery eyes

  • Facial pressure


These nasal features are a major reason migraines are mistaken for sinus headaches.


Why “Sinus Migraine” Is a Common Mislabel


Both migraines and sinus conditions can cause:

  • Facial pain or pressure

  • Nasal congestion or drainage

  • Watery eyes

Because migraine can activate autonomic nerves that affect the nose and eyes, it may feel like a sinus problem—especially during allergy season or after a cold.

In fact, studies consistently show that up to 90% of self-diagnosed sinus headaches are actually migraines.


migraine signs and symptoms

Who Is at Risk for Migraine?


Migraines can affect anyone, but certain factors increase risk:

  • Women are affected about three times more often than men

  • Family history of migraine

  • Hormonal fluctuations

  • Co-existing conditions such as anxiety, depression, or sleep disorders


What Is a True Sinus Headache?


A sinus headache occurs when the lining of the sinus cavities becomes inflamed—a condition known as sinusitis. The pain results from pressure and inflammation within the sinuses, not from neurological activation.

True sinus headaches are far less common than people think.

migraine signs and symptoms

Typical Features of Sinusitis-Related Headache

  • Pressure or fullness in the cheeks, forehead, or between the eyes

  • Thick nasal discharge (often yellow or green)

  • Nasal congestion and postnasal drip

  • Tooth pain or jaw discomfort

  • Reduced sense of smell

  • Fever (in some cases)

  • Pain that worsens when bending forward


Key Differences: Migraine vs. Sinus Headache


Pain Quality and Location

  • Migraine: Pulsing or throbbing pain, often unilateral, worsened by activity

  • Sinus headache: Deep, pressure-like pain over the sinuses with localized tenderness


Associated Symptoms

  • Migraine: Nausea, light and sound sensitivity, possible aura; nasal symptoms may occur

  • Sinus headache: Thick nasal discharge, congestion, postnasal drip, fever, reduced smell


Duration

  • Migraine: Typically lasts 4–72 hours per attack

  • Sinusitis-related headache: Persists 7–10 days or longer, tracking the course of infection or inflammation

migraine signs and symptoms

Why Misdiagnosis Is So Common


Migraines frequently cause nasal congestion and watery eyes, mimicking sinus disease. When this happens during allergy season or following a cold, the assumption of sinusitis is easy—but often incorrect.


Decongestants may offer little or no relief in migraine, which is another important diagnostic clue.


How an Accurate Diagnosis Is Made


Clinical Evaluation Matters Most

A careful medical history and focused exam are usually sufficient to distinguish migraine from sinus headache. Important clues include:

  • Presence of nausea or light/sound sensitivity

  • Triggers such as stress, sleep disruption, or skipped meals

  • Family history of migraine

  • Response (or lack of response) to sinus medications


Role of Imaging

  • Sinus imaging (CT or endoscopy): Reserved for chronic, recurrent, or complicated sinus disease

  • Brain imaging: Not routinely needed for stable, typical migraine


Treatment Options


Migraine Treatment


Acute (Abortive) Therapy

  • NSAIDs or acetaminophen at symptom onset

  • Triptans

  • Newer agents such as gepants (CGRP receptor antagonists) and ditans, which offer alternatives for patients who cannot tolerate or should avoid older therapies


Preventive Therapy

  • CGRP monoclonal antibodies

  • Beta-blockers

  • Topiramate

  • Certain antidepressants

  • OnabotulinumtoxinA (Botox) for chronic migraine


Lifestyle Foundations

  • Regular sleep and meals

  • Adequate hydration

  • Stress management

  • Trigger identification and avoidance


Sinus Headache (Sinusitis) Treatment


Symptom Relief

  • Saline nasal irrigation

  • Intranasal corticosteroid sprays

  • Humidification

  • Short-term use of topical decongestants (no more than 3–5 days)


Antibiotics

  • Not routinely needed

  • Considered only when criteria for bacterial sinusitis are met


Chronic or Recurrent Cases

  • Evaluation for allergies or structural issues

  • ENT referral when appropriate

  • Surgery is rarely required


When to Seek Specialty Care


Consider further evaluation if:

  • “Sinus headaches” are accompanied by nausea or light/sound sensitivity

  • Headaches last 4–72 hours and recur despite sinus treatments

  • Facial pain and congestion persist beyond 10–14 days or keep returning

  • Urgent care is needed for red flags such as:

    • Sudden, severe “worst headache of life”

    • New neurological symptoms

    • High fever, stiff neck, or vision changes


Bottom Line

Most headaches labeled as “sinus” are actually migraines. Recognizing the difference can prevent years of ineffective treatment and open the door to therapies that truly work.

A thoughtful medical evaluation—not guesswork—is the key to lasting relief.



References

David Klein MD Best Pain Doctor
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