The web site for people with sinus problems

Sinus Headaches versus migraines?

Is it a migraine or headache due to sinus disease?  This is a question that has puzzled millions of patients and many doctors for many years.  It's puzzled so many people because it's difficult to determine, in many cases, what is the source of the pain.  In fact, the symptoms of sinus disease and a migraine headache overlap substantially, causing much of the confusion for patients and doctors alike.

Based on the answers to the questions on sinusitis in other areas of this web site, you may have been directed here to review some of the symptoms of sinusitis.   This section may help you distinguish between migraines and headaches due to infection of inflammation of the sinuses or the nose. 

 Its more likely that you were referred to this section because you answered “yes” to the sinus-related symptoms of worsening nasal obstruction, abnormal nasal discharge, or decreased sense of smell, because these symptoms really do point towards the source as likely coming from the nose or sinuses. 

Here are some generalizations, that is some broad concepts, that help clinicians sort out what what's a migraine with pain over the sinuses and what is a sinus infection causing the pain.

Location of the pain.  It turns out that location of the pain or headache does not help much the diagnosis.  Migraine headaches can occur anywhere or over the face in head and can be mistaken for sinus headaches or allergies because of its location around the face, eyes, and sinuses.  Migraine headache can occur at the top or back of head, which can mimic symptoms of musculoskeletal pain, another very common condition.  Pain from a true sinus infection can also occur anywhere in the head, including the top of the head or the back of the head, so location is not particularly helpful in identifying or diagnosing  The type of headache a patient experiences.

The severity of the pain:   Severe pain in the case is more likely to be due to migraines than due to sinus infections.  This is just a statement of probability. It can't be used to diagnose any one particular patient.

Physicians typically asked patients to rate their pain on a scale of zero to 10, with zero being no pain and 10 being the worst pain they can possibly imagine.  Of course no two patients are likely to rate pain the exact same way, but there are some generalizations that can be made.  Specifically, patients that have headache above a seven out of 10 are more likely to have migraines than sinus disease causing the pain.  A headache rated seven or more is typically one that interrupts one's daily function.  Headaches eight or nine or 10 are likely to cause patients to lie down and rest.  Headaches that have become incapacitating, that is cause the patient to lie down and rest, are a most likely be migraines, but there are a number of other symptoms that are helpful in making this diagnosis.  We will call these associated migraine symptoms, and they will be the next concepts that we discuss.

Nausea and vomiting

Headaches associated with nausea and vomiting, or simply associated with nausea, increase the likelihood that the headaches will be due to a migraine.  Nausea occurs in about 80 to 90% of patients with migraines and vomiting occurs in about 30% of patients with migraines.  So nausea and vomiting that accompany headaches, recurrent headaches particularly, especially if the patient complains of pain that is greater than seven on a scale of 10 or pain that forces them to lie down and rest.  Patients that get nausea or vomiting with migraines may not get nausea and vomiting with every headache.  Other symptoms are helpful to look for.  Two of these are sensitivity to light and sensitivity to sound.

Phonophobia
Phonophobia is, simply put, sensitivity to sound.  Some patients but migraines will experienced phonophobia.  Others will not.  Patients with sensitivity to sound we'll describe having to turn down the TV or radio, may say that clanking silverware or loud conversation is uncomfortable, and these patients will typically retreat to a quiet room.  They liked the room should be dark because of the next important symptom: photophobia, or sensitivity to light.

Photophobia
Photophobia is sensitivity to light.  Again, some patients with migraines will experience photophobia.  These patients will be uncomfortable looking at a room light, ceiling light, or the bright sky.  They will put on sunglasses or retreat to a dark (and often quiet) room until the headache and photophobia subside.  Photophobia does not occur with many other headache syndromes other than migraine or migraine-like headaches.  When a physician can elicit a symptom of photophobia with headaches, particularly when the headaches are recurrent headaches, migraine is high on the list of possibilities, particularly with the headaches are recurrent headaches. 

It is important to emphasize that a diagnosis of migraine requires a history of repeated headaches (with other migraine symptoms noted above), rather than a single headache with these other symptoms this is an important point.  A patient with one, single, severe headache with photophobia might have a migraine, but other disorders need to be considered.  If a patient has a severe headache, fever, and photophobia he or she could even have a serious condition called meningitis, which would need to be treated emergently. 

Sensitivity to smells
Patient's who experience migraines many complain that smells trigger or exacerbate their migraines.  This is unusual for other sorts of headaches it would be unusual for sinus infections.  Patients with chronic sinus infections have alterations of their sense of smell, but the alteration is usually a loss of sense of smell or diminished sense of smell, not a feeling that odors are bothersome.

Nasal congestion and eye symptoms

About 40 to 45% of patients with migraines will complain of nasal congestion, (that is a sense of obstruction), rhinnorhea (runny nose), tearing from the eyes, or neck pain.  The nose and eye complaints sometimes make patients feel they have a sinus infection or allergy triggering the pain, but recurrent acute attacks of eye and nose symptoms accompanied by headaches are unusual for allergies or sinus infections.  Symptoms are typically chronic with allergies or sinus infections so they may last days to weeks or longer.   Nose and eye complaints with migraines last a few hours, and may range from 1-72 hours.