Common sinus headache symptoms such as congestion and head pain may actually be signs of a migraine attack. Learn how to tell the difference between migraine and sinus headache.

Many times when people have a runny nose, watery eyes and a headache, they assume they have a sinus headache. This is especially common during allergy season, when hay fever is at its peak. However, studies show that about 90% of self-diagnosed sinus headaches are actually migraine attacks.

The marketing of over-the-counter medications designed to treat allergy symptoms has reinforced the belief that sinus headache is a common illness, but in reality, sinus headache is not as common as you may think.

So how do you know if you have migraine or a sinus headache? Below we review the key symptoms of each and explain the main differences so you can get the treatment you need.

What is migraine?

Migraine is not just a bad headache. It’s a disabling chronic neurological disease with a range of symptoms and possible approaches to treatment. 

Common migraine symptoms 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

The American Migraine Foundation estimates that over 40 million Americans live with migraine. However, many people do not get an accurate diagnosis or the treatment they need, so the actual number is likely much higher.

Sinus Headache Symptoms and Treatment

A true sinus headache—called rhinosinusitis—is rare. The cause of a sinus headache is a viral or bacterial sinus infection characterized by thick, discolored nasal discharge. 

Sinus headache symptoms include:

  • Stuffy nose
  • Facial pain
  • Pressure around the eyes and behind the cheekbones
  • Weaker sense of smell or inability to smell
  • Aching in the upper teeth
  • Fever

Facial pain and headache should resolve within seven days after viral symptoms improve or, if a bacterial sinus infection is present, after successful treatment with antibiotics. If pain continues, then your doctor may reconsider the diagnosis of sinus headache and run additional tests to determine the cause of your symptoms.

Why is migraine often misdiagnosed as sinus headache?

Research studies show that some common allergy and sinus headache symptoms do occur with migraine. For example, one study found that 45% of people with migraine reported having at least one symptom of either nasal congestion or watery eyes during an attack. Migraine is also underdiagnosed and undertreated, meaning a self-diagnosis of migraine is less likely.

One study explored the frequent complaint of sinus headache by evaluating nearly 3,000 people, none of whom were diagnosed with or being treated for migraine prior to the study. Participants all reported at least six sinus headaches in the six months prior to the start of the study. Researchers found that 88% of the participants had migraine and not sinus headache.

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

The nerves that are activated during a migraine attack are the same nerves that supply the sinuses, eyes, ears, teeth and jaw. This can also help explain why migraine attacks are felt in the head, face, eyes, ears and sinuses. When the nerves that supply the sinuses are activated (from migraine or allergies) it can cause congestion, a runny nose and watery eyes. Because of this significant overlap in symptoms, it’s important to get an evaluation from a healthcare provider if you think you have sinus headache.

Sinus Headache vs. Migraine: Causes and Symptoms

So, how do you know if you are having migraine symptoms or a sinus headache? Take stock of your symptoms beyond the nasal and sinus congestion and the facial pain and pressure. Does your headache pain make you unable to function normally at work, school, home or social functions? Is your headache accompanied by nausea or sensitivity to light? 

You may also think about when you typically experience symptoms like head pain. Is it often triggered by weather changes, hormone fluctuations during a menstrual cycle or stress? These are all common triggers for migraine. In fact, people often think that weather changes give them a “sinus headache,” but these changes are frequently triggers for migraine.

Test: Is it migraine or sinus headache?

You can also ask yourself the following questions from the ID Migraine Questionnaire developed by Dr. Richard Lipton, 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 or 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 three questions, there is a 93% chance you have migraine. If you answer “yes” to all three, a migraine diagnosis is 98% likely.

Those with headaches from sinus disease are less likely to answer yes to the above questions.

If you think your sinus headaches could actually be migraine attacks, talk to your doctor or see a headache specialist. Your doctor may prescribe a migraine-specific medication to see if it helps reduce your head pain and other associated symptoms the next time you have a headache. If necessary, they might order lab work or a CT scan of your sinuses to rule out sinus disease or another 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.