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Sinus Headache or Migraine?

Sinus Headache is a common complaint in the general population. But just what is sinus headache? Common symptoms include facial pain and pressure, nasal and sinus congestion, and headache. Numerous over-the-counter medications are marketed for these symptoms and reinforce the belief that this condition is common. However, sinus headache is not as common as you may think.

"True" sinus headache, more properly called rhinosinusitis, is rare and secondary to typically a viral sinus infection characterized by thick, discolored nasal discharge, possibly decreased smell or no smell, facial pain or pressure and commonly fever. Any pain should resolve after completion of an appropriate course of antibiotics. If pain continues despite antibiotics, then your diagnosis should be reconsidered.

What is "sinus headache"? It is migraine with sinus symptoms. A very large study involving almost 3,000 patients was very important in evaluating the frequent complaint of "sinus headache". In this study, the participants had at least six 'sinus headaches' in the six months prior to entrance into the study. They had never been diagnosed with migraine and had never been treated with a migraine-specific medication.

The results? Eighty-eight percent of the participants were found to be having migraine headache and not sinus headache.
Strict criteria from the International Classification of Headache Disorders were used to tell the difference between headache types. In addition to their common symptoms of facial pain and pressure and nasal and sinus congestion, sufferers often had the following symptoms we associate with migraine:

  1. Nausea
  2. Sensitivity to light and/or noise
  3. Moderate to severe headache
  4. Pulsing/throbbing pain
  5. Headache worsened by activity

In this study, the almost 3,000 patients with the complaint of "sinus headache" were taking lots of over the counter and prescription decongestants, antihistamines, nasal sprays, analgesics, and anti-inflammatory medications. However, there was a lot of patient dissatisfaction with their results. The dissatisfaction makes sense since many actually had migraine producing the sinus complaints.

So, how do you know if your headache is migraine and not sinus? Ask yourself the following questions:

  1. In the last 3 months, how disabling are your headaches; do they interfere with your ability to function? (Are you missing work; school; family activities?)
  2. Are your headaches ever associated with nausea?
  3. Are your headaches ever associated with sensitivity to light?

If two of the above three criteria are present, migraine is likely 93% of the time. If all 3 are present a migraine diagnosis is 98% likely.

So what you think is a "sinus headache" may actually be a migraine with sinus symptoms. Knowing this can help with getting the right diagnosis and treatment.

Above content provided by the American Headache Society in partnership with Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2009

Contact Information

Arnold Pain Management Center
Beth Israel Deaconess Medical Center
One Brookline Place, Suite 105
Brookline, MA 02445