How to Spot the Difference Between Migraines & Sinus Headaches

If you have a runny nose, watery eyes and your head hurts, you might assume that you have a sinus headache. But studies show that about 90% of self-diagnosed sinus headaches are actually migraine.

There’s a belief that sinus headache is a common illness. The marketing of over-the-counter medications designed to treat these symptoms reinforce this belief.. However, a sinus headache is not as common as you might think.

How can you tell if you have migraine or sinus headache and get the treatment you need? Let’s start by defining migraine and sinus headache.

What is migraine?

Migraine is not just a bad headache. It’s a disabling neurological disease with different symptoms and different treatment approaches compared to other headache disorders. The American Migraine Foundation estimates that at least 39 million Americans live with migraine.  However, many people do not get an accurate diagnosis or the treatment they need so the actual number is probably higher.

Common symptoms of migraine include:

  • Moderate to severe head pain
  • Head pain that causes a throbbing, pounding, or pulsating sensation
  • Head pain that gets worse with physical activity or movement
  • Nausea and/or vomiting
  • Sensitivity to light, noise and/or smells
  • Nasal congestion and runny nose

What is sinus headache?

A true sinus headache, called rhinosinusitis, is rare. The cause is a viral or bacterial sinus infection characterized by thick, discolored nasal discharge. You’ll get symptoms like possibly weaker smell or no smell, facial pain or pressure and commonly, fever. Facial pain and headache should resolve within seven days after viral symptoms improve or after successful treatment with antibiotics (if a bacterial sinus infection is present). If pain continues, then your diagnosis should be reconsidered.

Why do we misdiagnose migraine as sinus headache?

Research studies show common sinus symptoms occur with migraine. In one study, 45% of migraine patients had at least one symptom of either nasal congestion or watery eyes. Migraine is also underdiagnosed and undertreated, meaning that a self-diagnosis of migraine is less likely.

A study involving almost 3,000 patients was important in evaluating the frequent complaint of sinus headache. In this study, the participants had at least six sinus headaches in the six months prior to entrance into the study. They had neither a migraine diagnosis nor treatment with a migraine-specific medication. What were the results? Eighty-eight percent of the participants had migraine and not sinus headaches.

Another study, called the American Migraine Study II, showed that many people who were diagnosed with migraine thought they had sinus headache. Significantly, there were almost 30,000 study participants—only about 50% who were diagnosed with migraine knew they had migraine before the study. The most common misdiagnosis was sinus headache.

How do I know if my headache is migraine or sinus headache?

So, how do you know if your headache is migraine and not sinus? Go beyond the nasal and sinus congestion and the facial pain and pressure; look for a headache associated with the inability to function normally at work, school, home or social functions, nausea, sensitivity to light and triggers such as weather change, menstrual cycle, and stress (all common triggers for migraine). Significantly, it is commonly thought that weather change often causes “sinus headache” when weather change is a common trigger for migraine.

You can also ask yourself the following questions from the ID Migraine Questionnaire developed by Dr. Richard Lipton of Albert Einstein College of Medicine:

  • In the past three months, how disabling are your headaches? Do they interfere with your ability to function? (Are you missing work; school; family activities?)
  • Do you ever feel nausea when you have a headache?
  • Do you become sensitive to light while you have a headache?

If you answer “yes” to two of the above three criteria, migraine is likely 93% of the time. If you answer “yes” to all three, a migraine diagnosis is 98% likely.

In the event  you feel that your sinus headaches could be migraine, ask your provider if a migraine-specific medication could be right for you. If so, try the migraine-specific medication for your next three “sinus headaches.” Look for the headache and associated symptoms to improve more than they did for previous treatments you were using. In some cases, a work-up may be done such as a CT scan of your sinuses to rule out sinus disease or simply to reassure you that the diagnosis is migraine and not a sinus problem.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.