Sinus Headache or Migraine? Setting the Record Straight
Posted by Teri Robert—April 4th, 2013

There’s often confusion about Migraines and “sinus headaches.” According to the Sinus, Allergy and Migraine Study (SAMS), “Sinus headache is the most frequently given erroneous diagnosis given to patients with Migraine.”1 SAMS also notes that:

“In the SUMMITstudy, 2,991 patients with a self-diagnosis or physician diagnosis of sinus headache were evaluated in a multicenter (453 site) study.9 Employing IHS (International Headache Society) criteria, 80% had migraine with or without aura.”1

The confusion is understandable given the symptoms often described:

  • facial pain around the eyes or along the sinuses,
  • nasal congestion,
  • rhinorrhea (runny nose),
  • eyelid edema,
  • conjunctival injection (forcing of fluid into the conjuctiva, the mucous membrane that lines the eyelids),
  • lacrimation (eyes tearing), and
  • ptosis (droopy eyelid).

Migraine-Trigeminal-Nerve

One reason Migraines can cause some of these symptoms that make people think they’re sinus headaches is the trigeminal nerve, which becomes inflamed during a Migraine attack. As you can see from the image to the right, the trigeminal nerve has three branches:

  • One branch runs above the eyebrows.
  • One branch runs below the eyes, near the sinus cavities.
  • One branch runs along the jaw.

Research has shown most self-diagnosed sinus headaches to be Migraine. in the Sinus, Allergy, and Migraine Study (SAMS), Eross et. al. concluded:

“The majority of those with self-diagnosed sinus headache have migraine or probable migraine. In those patients with migraine, the most common reasons for misdiagnosis include headache triggers, pain location, and associated features (“guilt by provocation, location, and association”) commonly attributed to sinus headache.”1

Triggers that most commonly brought on Migraines that were mistakenly diagnosed as sinus headaches included:

  • weather changes,
  • changes in altitude (including flying),
  • seasonal variation, and
  • exposure to allergens.

In the SAMS, of patients who had diagnosed themselves with sinus headaches, 83% actually had Migraine. Here’s the breakdown of correct diagnoses:

  • Migraine with aura or Migraine without aura: 52%
  • probable Migraine: 23%
  • chronic Migraine with medication overuse: 11%
  • seasonal headache secondary to rhinosinusitis: 3%
  • cluster headache: 1%
  • hemicrania: 1%
  • nonclassifiable headache: 9%

It’s not just patients who mistake Migraines for sinus headaches. Doctors often make the same mistake. Here’s a video with a patient who was misdiagnosed by both his family doctor and an ears, nose, and throat specialist. (Note that the doctor in the video does make an error. He says the patient has “classic Migraine,” now called Migraine with aura, although the patient says he has no aura. This would be Migraine without aura, previously called “common Migraine.”)

Rather than self-diagnosing and self-treating, anyone who thinks they have sinus headaches should consult a doctor. Anyone who has been diagnosed with sinus headaches, without a sinus infection, should consider getting a second opinion. Given the statistics from studies, unless there is infection present, most so-called sinus headaches are misdiagnosed and are actually Migraines.

Live well,
Teri Robert Signature

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