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. However, some studies have shown that approximately 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, 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?
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. 4.9 million people in Australia suffer from 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 on one side of the head
Head pain that causes a throbbing, pounding, or pulsating sensation
Sensitivity to light, noise and/or smells
Nausea and/or vomiting
Head pain that gets worse with physical activity or movement
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 has shown 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 evaluated the frequent complaint of sinus headache in approximately 3,000(1) patients. 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. Interestingly, eighty-eight percent of the participants had migraine and not sinus headaches.
Another study, called the American Migraine Study II(2), showed that many people who were diagnosed with migraine thought they had sinus headache. Significantly, of the 29727 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?
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. 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:
In the past three months, how disabling are your headaches? Do they interfere with your ability to function?
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.
Sinus headaches will tend to go away as your sinus symptoms such as fever, runny nose or congestion also alleviate. In some cases, a CT scan of your sinuses to rule in/out sinus disease may be used by your doctor.
If you feel that your sinus headaches could be migraine, ask your doctor if a migraine-specific medication could be right for you. If so, your doctor may suggest trying the migraine-specific medication for your next three “sinus headaches.” Compare the headache and associated symptoms when using the new medication to previous treatments to improve.
1. Schreiber, C P. et.al (2004) Prevalence of Migraine in Patients With a History of Self-reported or Physician-Diagnosed "Sinus" Headache. Arch Intern Med. 2004;164(16):1769-1772
2. Lipton, R B. et.al. (2001). Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II. Headache. 41:646-657
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