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Migraine or Sinus Headache?

Got frequent headache pain? Why you need to know whether it's a migraine or a sinus headache.
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WebMD Feature

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 with symptoms like pain in the head, stuffy nose, and watery eyes actually have migraine headaches.

"It's such a widespread misconception," says neurology professor 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 headache and migraine can have some symptoms in common, including:

Pain in the head, particularly the forehead.

  1. Itchy or watery eyes.
  2. Pain associated with movement.

But migraines are often also accompanied by other traits, including:

  1. Nausea or vomiting.
  2. Sensitivity to sound or light.
  3. Severe throbbing pain on one side of the head.

Migraine is usually to blame in people who have frequent, severe headaches, 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 help drainage.

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

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

Migraine treatment isn't just about stopping a migraine once it starts. It's also about preventing them and reducing their frequency, severity, and duration.

Drugs called triptans are used during a migraine attack to reduce pain and restore function.

Other drugs, first developed to treat epilepsy, depression, and hypertension can be used to prevent migraine attacks. Botox injections have also been used to help prevent chronic migraines. Hormone therapy may be prescribed for women who have migraines linked to their menstrual cycle.

Lifestyle also matters for migraines. Stress-reducing therapies -- such as exercise, relaxation, and biofeedback -- may also help prevent the recurrence and severity of migraines. Learning your migraine triggers and avoiding them also matters.

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 temporary 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 headache."

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