Migraine or Sinus Headache?

Headache pain along with a stuffy, runny nose and itchy, watery eyes. Sounds like a sinus headache, right? Think again.

More than 4 out of 5 people who think they have a sinus headache actually have a migraine.

"It's such a widespread misconception," says Peter Goadsby, MD, who heads the University of California, San Francisco's headache program. "It's the size of the problem that stuns me."

Here's why it matters: Treating a migraine like a sinus headache, or vice versa, doesn't work.

Differences in Symptoms, Causes

Sinus headaches and migraines can have some symptoms in common, including:

  • Pain in the head, particularly the forehead
  • Itchy or watery eyes
  • Pain when you move

But migraines often happen with other symptoms, including:

  • Nausea or vomiting
  • Sensitivity to sound or light
  • Severe throbbing pain on one side of the head

A migraine is usually to blame in people who have severe headaches that happen often, says neurology professor Stephen Silberstein, MD, of Thomas Jefferson University. He wrote the American Academy of Neurology's guidelines on migraine diagnosis and treatment.

"If you walk into your doctor's office with disabling headache pain that comes and goes, 95% of the time it's migraine," Silberstein says. "People with sinus infections don't complain of headache first. They say they are sick and have a headache."

Sinus headaches are usually caused by an infection and inflammation of the nasal passages. That leads to congestion. And that causes pain and pressure in the forehead and behind the cheekbones.

Different Treatments

For sinus headaches, treatment starts with decongestants, pain relievers, and nasal irrigation to ease sinus pressure and congestion, and to help drainage.

Antibiotics or nasal steroids are often a second line of attack to treat the underlying infection.

A sinus headache caused by an infection should go away soon after you start treatment.

Migraine treatment isn't just about stopping a migraine once it starts. It's also about preventing them and reducing how often you get them, how long they last, and how severe they are.

People can take drugs called triptans during a migraine attack to ease pain and get back to their daily activities.

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Other meds that were made to treat epilepsy, depression, and high blood pressure also can prevent migraine attacks. So can Botox shots. Women who have migraines linked to their menstrual cycles might get a prescription for hormone therapy.

Your lifestyle also matters. Things that ease stress -- such as exercise, relaxation, and biofeedback -- may also keep migraines away and make them less severe. It’s also important to learn the things that can trigger your headaches and avoid them.

Let's say you have a migraine. But you don't know that, and you treat it with pain relievers for what you think is a sinus headache.

That may make matters worse. You might get some short-term relief, but you could wind up with a "rebound" headache afterward.

"A lot of sinus medications contain analgesics [pain relievers]," Silberstein says. "Overuse of analgesics can cause rebound headaches."

Masquerading as a Sinus Problem

It's understandable to think at first that you've got a sinus problem if you have a headache, stuffy nose, and watery eyes.

But your body's pain response may have fooled you.

"If you give a human pain in the head, particularly in the forehead," Goadsby says, "there is a reflex that activates nerves that produce eye watering, itchiness of the eye, stuffiness, and runny nose."

"If you didn't know that all forms of pain do that, then those symptoms are [mistakenly] associated with sinus disease," Goadsby says.

When to Get Help

Make an appointment with your doctor if your headaches interfere with your daily life or don't get better with over-the-counter medications.

"If you are going to take medicine to treat a headache and are not sure what you have, it's a good time to see a doctor," Goadsby says.

But get medical help right away if you have a headache that:

  • Keeps getting worse.
  • Comes with other symptoms such as vision loss or muscle weakness.
  • Happens with a fever or stiff neck.
  • Comes on suddenly and feels like the worst headache of your life.

"If you're complaining to a doctor that you've got a headache that comes and goes, it should be considered migraine until proven otherwise," Silberstein says.

WebMD Feature Reviewed by Neil Lava, MD on May 13, 2016

Sources

SOURCES:

Peter J. Goadsby, MD, professor of neurology and director, University of California, San Francisco Headache Program.

Stephen Silberstein, MD, professor of neurology, Thomas Jefferson University, Philadelphia.

Schreiber, C. Archives of Internal Medicine, Sept. 13, 2004.

Eross, E. Headache, Feb. 2007.

American Academy of Neurology: "Migraine."

U.S. Department of Health and Human Services Office on Women's Health: "Migraine Fact Sheet."

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