If you have head pain around the eyes, cheeks, and forehead, your first thought may be a sinus headache. But that’s not always the case. In fact, studies suggest that up to 90 percent of the time, people who think they have a sinus headache are actually experiencing a migraine attack.

Overlapping symptoms between migraine and sinus problems can make it hard to tell the difference. But getting to the root of the problem is the only way to find treatments that work and avoid those that don’t.

What Is a Sinus Headache?

The sinuses are spaces behind your forehead, cheeks, and nose. A sinus headache is typically due to inflammation in the sinuses. The most common cause of inflammation is a sinus infection, also known as sinusitis. Sinusitis usually develops from a cold or allergies.

When the sinuses become inflamed or blocked, mucus builds up and causes pressure. This sinus congestion can lead to a deep, dull, or throbbing pain.

Other symptoms of sinusitis can include fever, fatigue, and green or gray mucus. You may have a reduced sense of smell and a stuffy nose. There’s constant facial pressure that can extend to the upper teeth. Pain usually gets worse when you bend your head forward or lie down.

Viral infections or bacterial infections can lead to sinus headaches. Allergies can also be to blame. The specific structure of your nose can also make some people more prone to sinus infections. For instance, a deviated septum or nasal growths called polyps may raise your risk.

Can Migraine Cause Sinus Pain?

Migraine is a neurological condition. Headaches are a common symptom of migraine, but they’re not the only one.

Migraine can activate the trigeminal nerve. This nerve plays a major role in facial sensation and sinus discomfort. Migraine pain can feel like you have pressure in your sinuses, even though you don’t have a sinus infection. It can even come with symptoms common in sinus infections, like forehead and cheek pain and a stuffy nose.

Migraines that mimic sinus headaches may include similar symptoms, like:

• Nausea or vomiting
• Pain in sinus areas (forehead, cheeks, around eyes)
• Sensitivity to bright light
• Stuffy nose
• Throbbing or pulsating pain
• Watery eyes
• Pain that worsens with physical activity

How To Tell the Difference

Because many symptoms overlap, it’s not unusual to mistake one condition for another.

One MyMigraineTeam member said they had trouble figuring out the cause of their nausea. “My nausea now is mainly related to migraine, the aura, lights, prisms, dancing red dots, color shifts, ice pick stabbing pain in my brain, throbbing pain, and burning sensations. But before sinus surgery, I think it was a mix.”

You may need to see a specialist to get a proper diagnosis. It’s more likely to be a sinus headache if:

• You recently had a cold or upper respiratory infection
• You have thick, yellow, green, or gray nasal discharge
• You have a fever
• The pain is steady rather than throbbing
• Pain improves as the infection resolves
• You feel significant facial pressure when bending forward

Migraine is more likely if:

• You were diagnosed with migraine in the past
• The pain is pulsing or throbbing
• You feel nauseous or sensitive to light, sound, or smell
• The headache lasts for hours to days without signs of infection
• Over-the-counter medications for allergies or cold symptoms don’t help
• Symptoms are triggered by stress, hormonal changes, or weather changes

Another important difference is that sinus headaches tend to happen with sinus infections. Migraine headaches often happen independently from infections or are triggered by circumstances, for example, changes in barometric pressure.

One member of MyMigraineTeam described having both conditions at the same time. “Sinus headaches, along with the migraine headaches, make it 100 times more painful.” Others have said that one condition led to another. For people with migraine, sinus problems can increase migraine activity, leading to more confusion about the true cause of symptoms.

Other Conditions That Could Be To Blame

While migraine is the most common cause, other headache-related conditions can also cause facial or sinus-like pain.

Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain disorder. It’s caused by damage or irritation of the trigeminal nerve. Symptoms usually include sharp, stabbing pain on one side of the face. Nearby muscles in your face may spasm during an attack. Afterward, you may have a lingering aching, burning, or throbbing sensation.

Different types of trigeminal neuralgia can cause persistent pain or intense, short-lived pain. Common triggers are smiling, eating, or brushing your teeth.

Doctors may prescribe antiseizure medications and muscle relaxants as first-line treatments. If these aren’t effective, surgery may be an option.

Other Types of Headaches

Tension headaches are the most common type of headache. They cause pressure on the forehead and sides of the head. If your symptoms are severe, you may feel like you have migraine or sinus problems. Tension headaches may happen if you’ve been straining your neck or eyes, if you’re sleep deprived, or if you’re stressed out.

Tension headaches usually go away without treatment or with over-the-counter pain relievers. But you should seek emergency care if you have shortness of breath, loss of balance, or changes in vision or speech.

When To See Your Doctor

Head and facial pain is worth a call to your healthcare provider, especially if it happens often or if it’s severe.

You should consider seeing a doctor if:

• Headaches keep coming back or get worse over time
• Pain is severe or interferes with daily life
• You frequently self-treat “sinus headaches” without relief
• You have symptoms of infection (fever, thick nasal discharge) that last more than 7 to 10 days
• You experience neurological symptoms (vision changes, confusion, weakness)
• You develop a sudden, severe headache

A healthcare provider will start by asking for a detailed medical history and reviewing your symptoms. Keeping a headache diary (where you write down your symptoms and daily habits) can give your healthcare provider useful information during your appointment.

Next, you’ll need a physical exam. Your provider will examine your nasal passages, looking for signs of infection or a blockage. They’ll check for facial tenderness and do a basic screening for neurological issues.

Checking your symptoms is usually enough to diagnose a sinus problem. But if your provider still isn’t sure what’s going on, you may need to have some imaging studies. A CT scan of the sinuses can detect an infection or blockage. An MRI of the brain may be done if neurological causes need to be ruled out.

If you have sinus issues often, your doctor may refer you to an allergist for allergy testing. A referral to a neurologist or an ear, nose, and throat (ENT) doctor could also be helpful.

Why the Right Diagnosis Matters

Treating a migraine as a sinus headache often leads to frustration. Decongestants, antihistamines, or antibiotics won’t relieve migraine pain, and repeated use of unnecessary medications can have side effects.

On the other hand, true sinus infections may require targeted treatment. Treatment can range from nasal sprays and decongestants to antibiotics. If allergies are to blame, antihistamines can help.

Understanding what’s actually causing your pain allows you to get effective treatment now and prevent future symptoms. It also keeps you from taking unnecessary medications.

“I was misdiagnosed with sinusitis for years and years, and was given so many antibiotics I didn’t need,” said a MyMigraineTeam member.

Not all facial pain is sinus-related, even if it feels that way. Paying attention to the full set of symptoms, not just where you have pain, can make all the difference in getting the right care.

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