Why Your “Sinus Headache” Might Actually Be a Migraine
Why Your “Sinus Headache” Might Actually Be a Migraine
After a long day, that dull ache behind your eyes morphed into a throbbing pressure, stretching across your forehead and cheeks. With your head in your hands, you might wonder: Is this a migraine? A sinus headache? Something worse?
Headache pain is notoriously difficult to decode. Many people mistake migraine symptoms for sinus headache because both can cause facial pain and pressure. But knowing the difference is important because the right diagnosis can lead to the right treatment—and faster relief.
To help untangle the confusion, two University of Utah Health experts explain how to tell the difference between a true sinus headache and migraine.
What Is a True Sinus Headache?
Pressure in your face doesn’t automatically mean a sinus headache. In fact, true sinus headaches are uncommon.
“People get confused because they say, ‘My pain is right in my sinuses, so it must be a sinus headache,’” says Kathleen B. Digre, MD, the former chief of the Division of Headache and Neuro-Ophthalmology at University of Utah Health. “But most people have migraines and do not have sinus headaches.”
Digre says many patients spend years treating what they believe are sinus headaches before learning they’re actually experiencing a migraine.
A true sinus headache happens when you have acute rhinosinusitis—inflammation of the nasal passages and sinuses usually caused by a viral infection or a cold. A provider can confirm the diagnosis through imaging, nasal endoscopy, or a clinical exam.
These symptoms include:
- Thick, discolored mucus (dark green, yellow drainage)
- Fever
- Symptoms lasting seven to 10 days with no improvement
- Pain that worsens as the sinus infection worsens
If you have these symptoms, see your doctor as soon as possible. They can determine whether you have a bacterial infection, which must be treated promptly.
Signs That Point to a Migraine
Migraine can cause much more than head pain. Symptoms that strongly point to migraine include:
- Light sensitivity
- Sound sensitivity
- Smell sensitivity
- Nausea or vomiting
- Throbbing pain
- Worsening with activity
- Attacks lasting four to 72 hours
- Recurring episodes over months or years
Migraine symptoms that mimic a sinus headache include:
- Facial pressure
- Nasal congestion
- Runny nose
- Pain that worsens when bending forward
Because these symptoms overlap with sinus infections, it can be difficult to know which condition is causing your pain.
Why the Right Diagnosis Matters
Migraine affects 20% of women and 10% of men, yet many people never receive a diagnosis. Instead, they continue treating symptoms that may not be caused by sinus disease at all.
“When people don’t get the right treatment, migraine can get worse and worse,” Digre says. “About 5% of people have chronic migraine—more than 15 days a month. That’s why it’s so important to know what you’re treating to get the right diagnosis and finally get some relief.”
When to Seek Medical Care
If you’re unsure whether you’re dealing with a sinus headache or migraine, start with your primary care provider. They can evaluate your symptoms and determine whether imaging or antibiotics are appropriate.
If you have a migraine, treatment may include:
- Migraine-specific pain relievers, such as triptans or gepants
- Preventive migraine medications
- Neurology care
If you have sinusitis, treatment may include:
- Saline nasal rinses
- Nasal steroid sprays
- Antibiotics, but only after seven to 10 days of persistent symptoms
Specialized Care for Migraine
If headaches are frequent, severe, or interfering with your daily life, you may benefit from seeing a headache specialist.
At University of Utah Health, otolaryngology (ears, nose, and throat) and neurology teams are dedicated to getting patients on the right treatment path.
“We’re very focused on patient‑centered, evidence‑driven care,” says Kristine Smith, MD, associate professor in the Department of Otolaryngology–Head & Neck Surgery and a fellowship-trained rhinologist at University of Utah Health. “We can offer rapid access to care teams to help diagnose a true sinus infection from a viral infection or a headache.”
U of U Health’s Headache Clinic offers specialized care from providers who focus on headache disorders, including:
- United Council for Neurologic Subspecialties‑certified headache specialists
- An infusion clinic for acute migraine care
- Nurse practitioners and pharmacists trained in migraine management
- Headache School, a series of short, patient‑friendly educational videos for patients
- A free online headache guide with information about diagnosis and treatment
If you’ve been treating what you think is a sinus headache without lasting relief, it may be time to talk with your health care provider. Getting the right diagnosis can help you find treatment that works—and get back to feeling like yourself.
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