Sinus Headaches vs Migraines: How to Tell the Difference

Madeleine Herman, MD

Many patients assume facial pressure or forehead pain must be a sinus headache, especially during allergy season or when congestion is present. However, studies show that most headaches attributed to sinuses are actually migraines.

Understanding the difference is important because treatment for sinus headaches and migraines is very different, and misdiagnosis can lead to prolonged symptoms and frustration.

At SCENT Houston – Sinus Center & ENT Specialists of Houston, we frequently help patients distinguish between sinus-related pain and migraine headaches to ensure the most effective treatment.

What is a Sinus Headache?

A sinus headache occurs when the sinus cavities become inflamed or infected, leading to pressure buildup inside the sinuses.

Sinus headaches are usually associated with sinusitis (sinus infection) or significant sinus inflammation.

The sinuses are air-filled spaces located in the:

• Forehead (frontal sinuses)

• Cheeks (maxillary sinuses)

• Between the eyes (ethmoid sinuses)

• Deeper behind the eyes (sphenoid sinuses)

When these areas become inflamed, pressure and discomfort can develop.

Common Symptoms of a Sinus Headache

Symptoms typically include:

• Pressure in the forehead, cheeks, or around the eyes

• Facial pain that worsens when bending forward

• Nasal congestion

• Thick nasal drainage (often yellow or green)

• Reduced sense of smell

• Ear pressure

• Tooth discomfort (especially upper teeth)

• Fever (in acute sinus infection)

• Fatigue

Sinus headaches usually occur along with other sinus symptoms, not in isolation.

What is a Migraine?

Migraines are a neurological condition involving hypersensitivity of pain pathways in the brain.

Migraines can cause head pain that mimics sinus pressure, which is why they are often confused.

Migraine symptoms often include:

• Moderate to severe head pain

• Throbbing or pulsating pain

• Pain on one side of the head (but can occur on both sides)

• Sensitivity to light

• Sensitivity to sound

• Nausea or vomiting

• Visual changes (aura)

• Worsening pain with activity

• Fatigue or brain fog

Migraines may also cause:

• Nasal congestion

• Runny nose

• Eye watering

• Facial pressure

These overlapping symptoms commonly lead to confusion.

Key Differences Between Sinus Headaches and Migraines

Feature	Sinus Headache	Migraine
Cause	Sinus inflammation or infection	Neurological condition
Pain location	Forehead, cheeks, around eyes	Often one side of head
Pain type	Pressure sensation	Throbbing or pulsating
Nasal symptoms	Common	Sometimes present
Fever	Possible	Rare
Nausea	Rare	Common
Light sensitivity	Rare	Common
Sound sensitivity	Rare	Common
Duration	Often persistent	Episodes lasting hours to days
Triggered by bending forward	Often worse	Sometimes worse
Thick nasal mucus	Common	Rare

Why Migraines Are Often Mistaken for Sinus Headaches

Research shows that up to 90% of self-diagnosed sinus headaches are actually migraines.

Reasons include:

• Migraines can cause facial pressure

• Migraines can cause nasal congestion

• Migraines can cause watery eyes

• Weather changes can trigger migraines

• Allergy season can trigger migraines

• Patients associate facial pain with sinuses

Patients may repeatedly receive antibiotics without lasting relief because the underlying issue is neurological rather than infectious.

When is a Headache More Likely Sinus-Related?

A headache is more likely related to sinus inflammation when symptoms include:

• Thick nasal drainage

• Significant nasal congestion

• Fever

• Reduced smell

• Facial pain lasting more than 7–10 days

• Symptoms worsening after a cold

• Tenderness over sinuses

• Symptoms consistent with sinus infection

Chronic sinus inflammation may also cause:

• Persistent facial pressure

• Nasal blockage

• Post-nasal drip

• Fatigue

• Reduced smell

When is a Headache More Likely a Migraine?

Migraine may be more likely when symptoms include:

• Sensitivity to light

• Sensitivity to sound

• Nausea

• Vomiting

• Pulsating pain

• Visual aura

• Headache triggered by stress

• Headache triggered by sleep changes

• Headache triggered by hormonal changes

• Family history of migraines

• Headaches lasting hours to days

• Recurrent episodes with similar pattern

Migraines often occur without fever or thick nasal drainage.

Can You Have Both Sinus Headaches and Migraines?

Yes.

Patients with allergies or sinus disease may also experience migraines.

Sinus inflammation can sometimes trigger migraines due to nerve irritation.

Both conditions may need to be addressed for optimal symptom relief.

How ENT Specialists Evaluate Sinus Headaches

Evaluation may include:

Medical History

Discussion of:

• Headache pattern

• Nasal symptoms

• Allergy history

• Frequency of infections

• Triggers

• Sleep symptoms

Nasal Examination

Physical examination of nasal passages.

Nasal Endoscopy

A small camera may be used to examine:

• Sinus drainage pathways

• Inflammation

• Nasal polyps

• Structural obstruction

CT Scan of the Sinuses

Imaging may be recommended when:

• Chronic sinusitis is suspected

• Symptoms persist despite treatment

• Surgery is being considered

CT imaging helps confirm whether sinus inflammation is present.

Many patients with migraine have normal sinus CT scans.

Treatment for Sinus Headaches

Treatment depends on the underlying cause.

Options may include:

Nasal Treatments

• Saline irrigations

• Nasal steroid sprays

• Antihistamine sprays

Allergy Treatment

• Antihistamines

• Allergy testing

• Immunotherapy (allergy drops or shots)

Treatment for Sinus Infection

• Antibiotics (when bacterial infection is present)

• Oral steroids (in select cases)

Sinus Procedures

When structural issues contribute:

• Balloon sinuplasty

• Endoscopic sinus surgery

• Septoplasty (if nasal obstruction present)

Treatment for Migraines

Migraine treatment may include:

• Prescription migraine medications

• Preventive medications

• Lifestyle modification

• Sleep optimization

• Trigger management

• Neurology referral when appropriate

Correct diagnosis significantly improves outcomes.

When to See an ENT Specialist

Consider evaluation if:

• Headaches occur with nasal congestion

• Facial pressure persists despite medication

• Recurrent sinus infections occur

• Symptoms do not improve with typical migraine therapy

• Nasal obstruction is present

• Reduced sense of smell occurs

• Chronic post-nasal drip is present

Accurate diagnosis helps prevent unnecessary medications and persistent symptoms.

Why Choose SCENT Houston?

SCENT Houston provides comprehensive evaluation of sinus and nasal conditions contributing to facial pressure and headaches.

Care includes:

• Detailed nasal examination

• Nasal endoscopy

• In-office CT imaging when appropriate

• Evaluation of structural causes of obstruction

• Allergy evaluation when indicated

• Personalized treatment planning

• Focus on long-term symptom relief

• Transparent pricing

• Same-week appointments often available

Both sinus and migraine causes are considered when developing treatment recommendations.

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