Migraine vs. Sinus Headache

Medically Reviewed by Jennifer Robinson, MD on March 15, 2023
3 min read

You've got a stuffy, runny nose, and your forehead and cheeks hurt. That means you have a sinus headache, right? Maybe not. Headaches and nasal congestion are also symptoms of migraine.

It's a common misunderstanding. Misdiagnosis happens so often that one study found 95% of people who thought they had a sinus headache actually had a migraine.

So how can you tell the difference?

Both sinus headaches and migraines can cause:

  • Runny nose
  • Stuffy nose
  • Watery eyes
  • Pressure in your forehead and cheeks

The snot from a sinus headache will be yellowish mucus or pus, but drainage with a migraine is clear.

When it's a sinus headache, you could also have:

  • Fever
  • Foul-smelling breath

A migraine may cause:

Migraines also tend to run in families and are three times more likely in women.

If you're still on the fence about what's behind your pain, ask yourself:

  • In the last 3 months, have my headaches often caused trouble with my daily life?
  • Do I often feel queasy when I have a headache?
  • Do light and sound bother me when I get one?

If you answered "yes" to at least two of these questions, there's a very good chance you have migraines.

The result is the same: Your head hurts. Does it really matter why? Yes, because the diagnosis directs the treatment.

For a sinus headache, the focus is on draining the fluid from the mucus-filled spaces behind your cheeks to relieve the pressure and pain, as well as cooling the inflammation. Typically, you'll take decongestants, antihistamines, or antibiotics, or a combination of these medicines. This wouldn't help, and may even be harmful, for someone with a migraine.

It’s also possible to relieve sinus pain and pressure using a bioelectronic device that emits microcurrent waveforms. Sold over-the-counter, the device targets blood vessels and nerves to get relief. 

Scientists think migraines happen because of a series of changes in your brain stem, nerve cells, and brain chemicals. No one knows exactly why they start, but they can be triggered by certain foods, activities, or other conditions.

Treatment for migraine can include over-the-counter pain relievers as well as prescription drugs that are also used to treat seizure disorders, depression, and heart conditions. Other remedies might come as pills, shots, and nasal sprays.

People who often have allergies with a runny nose are 10 times more likely to have migraines. Asthma and migraine also share some of the same triggers.

So, do sinus and breathing problems cause migraines? Probably not, but it seems these conditions could be related somehow. To get relief, you’ll need the right diagnosis. If you have more than one condition, consider treatment for each separately, even when they’re happening at the same time.

Make an appointment when your headaches:

  • Are coming more often or are more severe
  • Don't get better with over-the-counter medications
  • Keep you from working, sleeping, or doing your normal activities
  • Cause other problems

It's likely that your doctor will talk to you about your health, both now and in the past, and run some tests to rule out other possible causes of your head pain before coming up with a treatment plan.

A severe headache may be a symptom of a serious condition such as a stroke, meningitis, or encephalitis. Seek emergency care if you:

  • Are confused or have trouble understanding speech
  • Faint
  • Have a fever over 102 F
  • Are numb, weak, or paralyzed on one side of your body
  • Have a sudden and severe headache
  • Have a stiff neck