The sinuses are normally clear and filled with air, but they can sometimes become irritated, inflamed, and infected. Known as sinusitis,this can happen if the sinuses can’t drain properly and become blocked, which can provide an opportunity for infectious germs to grow there. Allergies, viral infections, and in extremely rare cases, bacterial infections can cause congestion and swelling in the sinuses, says Christopher Gottschalk, MD, a headache specialist at Yale Medicine and professor of neurology at Yale School of Medicine. This article explores the causes, symptoms, diagnosis, and treatment of sinus headaches, and distinguishes between sinus headaches and migraines.
Sinus Headache vs. Migraine Headache
In fact, the American Academy of Otolaryngology–Head and Neck Surgery Foundation notes that over 80% of people who have self-diagnosed themselves or received a formal diagnosis of sinus headache actually have a migraine headache or tension headache; only around 3% to 5% of people diagnosed with sinus headaches actually have sinus headaches. This happens because some of the symptoms of migraine headaches are very similar to the symptoms of sinus headaches. Migraine headaches can trigger the parasympathetic nerves that control the mucosa in the sinuses, resulting in symptoms such as congestion, runny nose, redness or swelling around the eyes, and pressure in the sinus area, says Dr. Gottschalk. For this reason, migraine attacks that include these symptoms are often mislabeled as sinus headaches, because it is believed that the sinus irritation is the cause of the pain; however, the sinus symptoms are caused by the migraine process itself, explains Dr. Gottschalk. Even patients with migraines think there is a difference between their severe, throbbing, nauseating attacks, which they believe are migraines, and the milder ones with stuffiness and aching pressure above or behind the eyes, which they believe are sinus headaches, says Dr. Gottschalk. He explains that these are in fact two versions of the same thing: severe vs. mild migraines.
How to Differentiate Between a Sinus Headache and a Migraine
Sinus headaches are accompanied by fever and thick, discolored nasal discharge. If your head or other parts of your face hurt but you don’t have fever or congestion, and your nasal discharge is clear, it’s probably a migraine headache. Migraines are often accompanied by nausea and sensitivity to sound and light.
Symptoms of Sinus Headaches
These are some of the symptoms of sinus headaches:
Pressure-like pain in specific parts of your head or face, on one or both sidesA dull ache behind your eyes, forehead, cheekbones, the bridge of your nose, or upper teethPain that gets worse if you bend forward or move your head suddenlyPain that is worse in the morning, because mucus accumulates in the nasal passages overnightPain that becomes more acute when you experience temperature changes, such as going out into the cold after being in a warm roomFeverNasal congestionThick yellow or green mucus discharge from your noseSore throatPost nasal dripPuffy, swollen, or tender faceDiscomfort or a feeling of fullness in your earsTearing or redness in the eyesInability to smell
Causes of Sinus Headaches
A sinus headache is caused by sinusitis, which occurs when there’s a mucus buildup in the sinuses, giving bacteria, viruses, or fungus an opportunity to grow there and cause an infection. As the sinus cavities swell and fill up with liquid, they can cause tenderness and pain in the face. These are some of the causes of sinusitis:
Respiratory infections, with the common cold and flu being the most frequent culprit Allergies, such as hay fever Swelling, bone spurs, polyps, or tumors in the nasal passage, which can block the sinuses from draining properly A deviated septum or cleft palate, which can also affect the draining of the sinuses Flying or climbing to high altitudes, which can cause the mucosal lining in the sinuses to become swollen due to the differences in atmospheric pressure Frequently swimming or diving, which can cause irritation in the sinuses
Diagnosing Sinus Headaches
The diagnostic process may involve:
Questions regarding your symptoms and medical history A physical examination, wherein the doctor may lightly press your face to check for tenderness, look in your nose to check for discharge and congestion, and shine a light through your sinuses to check for inflammation. A nasal endoscopy procedure, which involves inserting a thin tube with a tiny light and camera into your sinuses, to determine whether there is allergy or acute infection, says Dr. Gottschalk. Imaging tests such as an x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI), that can reveal sinus blockages or help rule out other brain conditions. Your healthcare provider may suggest these if you have severe or unusual symptoms.
Migraine Misdiagnosis
It’s important to note that migraine headaches are often misdiagnosed as sinus headaches. “Any time a practitioner or patient thinks it’s a sinus headache, chances are that it’s actually a migraine. Physicians need to familiarize themselves with these concepts to improve the diagnosis and treatment of migraines,” says Dr. Gottschalk. However, there may be a misdiagnosis if clinicians use antibiotic medication to treat sinus headaches, explains Dr. Gottschalk. “If the symptoms get better on their own in a few days, the patient and the clinician think, ‘Aha! We got it right!’ and then continue to treat future attacks the same way.” Dr. Gottschalk explains that this can be problematic not only because you have to contend with the headache for a few days instead of a few hours, but also because it leads to the unnecessary use of antibiotics, which increases the risk of drug-resistant bacteria.
Treating Sinus Headaches
Treating sinus headaches generally involves treating the underlying sinusitis that’s causing it. Sinusitis caused by a viral infection such as the common cold cannot be cured, but a cold typically runs its course and gets better on its own in a week to 10 days. Antibiotic medication can help if it is in fact a bacterial infection; however, it is not recommended to prescribe antibiotics until migraine medication is prescribed and migraines are ruled out. Your healthcare provider may prescribe the following medications for symptom relief:
Painkillers to ease the headache and fever Antihistamines to reduce allergy symptoms Decongestants to clear congestion and swelling in the nose and sinuses Steroids to prevent inflammation Nasal spray or drops to relieve congestion
A Word From Verywell
Sinus headaches can be caused by sinusitis, but they are in fact an extremely rare condition that are usually a misdiagnosis of migraine headaches. If you suspect you have a sinus headache, it can be helpful to see a specialist for an accurate diagnosis and try migraine treatment first.
