You feel pain and pressure in your face, especially above and around the eyes, and you’ve got a runny nose. Is it migraine (a primary headache), or is it a sinus headache (a secondary headache)?
Especially during allergy season, most people self-diagnose a sinus headache. However, according to the American Migraine Foundation (AMF), studies indicate about 90% of these headaches are actually migraine attacks.
The barrage of marketing for over-the-counter allergy relief medications has reinforced the belief that sinus headache is a common condition; however, sinus headache isn’t as prevalent as you may think.
Here’s how you can tell the difference, so you’ll know what medical attention you need.
Migraine basics
We’ve covered this topic before, but it bears repeating here.
Migraine isn’t simply a bad headache; headache is just one component. Migraine is a chronic neurological disease that comes with a variety of disabling symptoms, including pain, and a number of different approaches to treatment.
Common migraine symptoms include:
- Moderate-to-severe, one-sided head pain
Pain that throbs, pounds, or pulsates
Pain that worsens with movement
Nausea and/or vomiting
Sensitivity to light, noise, and/or smells
Nasal congestion and runny nose
The AMF estimates that over 40 million Americans live with migraine. Since many people don’t get either an accurate diagnosis or the proper treatment they need, though, the actual number is likely much higher.
Sinus headache basics
A true sinus headache — called rhinosinusitis — is rare. The real cause of most sinus headaches is an underlying infection of the nasal sinuses characterized by thick, discolored nasal discharge. That makes the pain a secondary headache.
Sinus headache symptoms include:
- Stuffy nose
Facial pain
Pressure around the eyes and behind the cheekbones
Weak sense of smell or inability to smell
Aching in the upper teeth
Fever
If your infection is viral, the facial pain and headache should resolve within seven days. If the infection is bacterial, they should resolve after successful treatment with antibiotics. If your pain continues despite treatment, your doctor may review their diagnosis of sinus headache and run additional tests to determine the true cause of your symptoms.
Why is misdiagnosis common?
Research studies show that some common allergy and sinus headache symptoms present along with migraine. One study found that 45% of people with migraine reported either nasal congestion or watery eyes during an attack. In addition, migraine is underdiagnosed and undertreated, meaning self-diagnosing a migraine attack is less likely than a sinus headache.
Another study delved into the frequent complaint of sinus headache by evaluating nearly 3,000 people; none were diagnosed with or being treated for migraine prior to the study. All participants reported a minimum of six sinus headaches in the six months prior to the study’s start. The researchers found, though, that 88% of the participants had migraine and not sinus headache.
A study called the American Migraine Study II looked at nearly 30,000 individuals, and only about 50% who were eventually diagnosed with migraine knew they had migraine before the study began. The most common misdiagnosis for the remainder was sinus headache.
The nerves activated during a migraine attack are the same nerves that also supply the sinuses, ears, eyes, teeth, and jaw, helping to explain why migraine attacks are felt in these regions. When the nerves supplying the sinuses are activated (from migraine or allergies) it can lead to congestion, a runny nose, and watery eyes. Because of the symptom overlap, it’s crucial to get an evaluation from a healthcare provider, so you can receive appropriate treatment.
A quick and easy test
You can also ask yourself the following questions from the ID Migraine Questionnaire developed by Dr. Richard Lipton of the Albert Einstein College of Medicine:
- In the past three months, how disabling were your headaches?
- Do your headaches interfere with your ability to function?
- Do your headaches make you miss work, school, or family activities?
Do you ever feel nauseous when you have a headache?
Do you become sensitive to light while you have a headache?
If you answer “yes” to the last four questions, the likelihood of a migraine diagnosis is 98%.
Those with sinus headaches are less likely to answer yes to any of the above questions.
If you believe your sinus headaches might actually be migraine attacks, talk to your primary care provider or see a headache specialist. Your doctor may prescribe a migraine-specific medication to see if it reduces your head pain and related symptoms the next time you have a headache. If necessary, they might also order blood work or a CT scan of your sinuses to rule out an underlying sinus problem.
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