Migraine or ‘sinus headache’?

The symptoms of migraine disease are commonly mistaken for those of another condition. This means that people with migraine are often misdiagnosed and don’t receive appropriate treatment. One of the most common conditions confused with migraine is ‘sinus headache’.

In fact, a true ‘sinus headache’ is not very common. It is caused by an acute viral or bacterial infection of the sinuses, those hollows in the bones of the face that help filter the air we breathe, and which get filled with thick yellow or green snot when infected. Other signs of sinus infection (acute sinusitis) are fever, reduced ability to smell and stuffy nose. The facial pain and headache associated with sinusitis should improve in 7-10 days for viral infections or after a course of antibiotics for bacterial infections. If the sinusitis becomes chronic, these symptoms of thick nasal discharge, stuffy nose, loss of smell continue on for at least three months. Chronic sinusitis may be set off by allergies.

By contrast, symptoms of a migraine attack include moderate to severe head pain that is worse with movement or physical activity, nausea and/or vomiting and sensitivity to sound, light and smells. The attack usually resolves within 72 hours. None of these are features of a ‘sinus headache’. The key differences are the shorter time to resolution; the tendency of the pain to interfere with usual activities, and that people often want to lie still and quiet in a dark room; and the other migraine symptoms.

Migraine is much more common than sinusitis. In one study that evaluated nearly 3000 people with self-described or doctor-diagnosed ‘sinus headache’, 88% were subsequently diagnosed with migraine disease or probable migraine.

So why are do so many people with migraine think they have or are told they have ‘sinus headache’? One reason is that a runny nose and watery eyes quite often occur with a migraine attack. Migraine pain can be felt in the face, under or behind the eye, in the cheek and forehead, just like sinus pain. People with migraine may be more likely to have hayfever and sinusitis. Finally, hayfever or allergies may trigger a migraine attack, but if migraine is not diagnosed, the headache symptoms may be misattributed to hayfever or ‘sinus headache’. In these cases, it’s likely that both allergic and migraine disease need to be treated.

Maybe we should stop using the term ‘sinus headache’ completely, given that it is so often an incorrect description of what is actually going on. Let’s talk about ‘headache’ as a symptom that people experience, but which is not a diagnosis and needs further questioning and investigation to discover the cause.