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Sinus Headache or Migraine? Setting the Record Straight

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. Eross, Eric, DO; Dodick, David, MD; Eross, Michael. "The Sinus Allergy and Migraine Study (SAMS)" Headache 2007;47:213-224.    2. International Headache Society. "International Classification of Headache Disorders, 2nd Edition" (ICHD-II), First Revision. May, 2005.

Comments

  • zippy36
    5 years ago

    This is how my diagnosis began. I do have allergies and constant sinus problems. Back in the late 70’s I also had Bronchitis every winter. The pain in my head was frequent and sometimes terrible. My migraines were called “Sinus Headaches” and this diagnosis was reinforced by family members who also had “Sinus Headaches”. This was the case back in the 70’s but it was realized much later that they were indeed all migraines.
    This being said, I do occasionally get colds and sinus infections. These conditions do make me so much more susceptible to a migraine. I do not have chronic migraine but the past two weeks had to go to the doctors office twice and the ER once to get relief from severe pain and nausea that did not respond to my medication. I just had a cold and it was determined that I do have a sinus infection right now. Care has to be taken when someone who suffers from migraine gets sick. I was doing everything right as I have been through this many times. It just seems like I better get used to the illness/migraine connection. Even without the presence of a sinus infection I will suffer a migraine at the onset of a mild cold. I just don’t know if there is any preventative for this. I really makes a cold unbearable.

  • Kathy T
    5 years ago

    This was the story of my life. It took 10+ years to be diagnosed with migraines after years of allergy medications, ENTs, allergist & allergy shots (although allergies also exist), before I finally was diagnosed with migraines. Seeing a specialist has helped me to feel validated in my pain and that I am right to seek help.

  • Mary Worth
    5 years ago

    I can’t tell you how many doctors I went to thinking I had a sinus infection. When there was no infection they would prescribe decongestants to relieve the pressure. Once I started crying because the pain was so bad and he gave me percocet. Another doctor actually told me I was having “too many sinus headaches”. Like I was choosing to be miserable. I wasn’t diagnosed with migraine until I had an intractable migraine and which lasted six months. I’m now getting Botox, using Cefaly, Frova, and the occasional pain meds and have some control over my life again.

  • tucker
    6 years ago

    This is so complicated – I KNOW I have allergies and asthma -I’ve tested positive twice – right now I have classic symptoms of spring time allergies and just asked for a replacement of the Nasonex I had stopped using several months ago. But it’s never gotten so bad I’ve thought I’ve had an actual sinus infection. And while it’s been getting better over the months, nausea has been my constant companion for years now – we don’t know if it’s meds, part of some long term illness, or what.

    However, I constantly get those “facial headaches” that I first try treating with the sudafed/advil combo and if that doesn’t work, then I try the big guns. Mine seem to always start in the afternoon at work – I think it’s the gooey, dusty vent usually on AC even in the winter that’s just to my left overhead so all that nasty stuff blows down on my face. I’ve told my boss but no help. LOL – I even tried to climb up there on a Sat and block the vent but it was just out of my reach!

    It’s so complicated with other factors involved-food, sleep, beverages we drink, weather!!!!, life, work stress – sigh…..

  • Garangwyn
    6 years ago

    This is exactly what happened to me. When I first began having migraines, probably 20 years ago, I was certain it was a sinus headache due to allergies (because of the location) and suffered for 6 weeks before I finally went to the doctor in tears, believing it had to be a sinus infection — although I had none of the symptoms of an infection. He sent me for a sinus x-ray, although he was dubious — he immediately dx’d me with migraine, and the x-ray was just to be sure. Sure enough, no infection. He told me I would have to figure out what the trigger was. Not knowing about the trigeminal nerve, I thought since it felt so much like sinuses, maybe dairy products were triggering it (producing congestion which was not there any longer) so I quit eating the cottage cheese that I had been eating daily on my diet. After the migraine subsided, two weeks later I tried cottage cheese again, and had an immediate migraine. I was daily giving myself another migraine for six weeks!! It only felt like a sinus headache because of the trigeminal nerve, which I still knew nothing about — only that a migraine could mimic a sinus headache. The stats above don’t surprise me a bit! Since then I have tried to educate sufferers that their “sinus headaches” might be something else. Some follow up; some don’t believe me.

  • davidgarrison
    6 years ago

    Wow, story of my life. Wasted lots of time going to all kinds of Sinus specialist and having face x-rays and tons of meds. I guess the major sign and problem I have is nasal congestion, it the first sign I have that leads to a migraine and never have aura. I find relief with Imtrex or Bualbital-Caffeine, but has any one with similar symptoms found a daily preventive med that works for them. I think i have tired everything, including botox and steroid injections in the nerve. Special diet is helping, but wish I could knocked the down even more…:)

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