Sinus headache symptoms are so common that many people just shorten the phrase to “I have sinus. " This can encompass anything from pain around the eyes and nose to runny nose, nasal congestion, watery eyes, sore throat, fever, chills and fatigue. The problem arises when the person has allergies and perhaps even migraine headaches. Then the situation is really muddled! Which is it: sinus infections, sinusitis or migraine?
Here is how you might be able to tell the difference. Let's start with sinus infections. This usually is an acute infection of the sinuses with fever, chills and yellow or green discharge from the nose. There is pain in the sinuses over the eyes, beneath the eyes and may even extend to pain in the upper teeth. The pain is constant and somewhat throbbing and usually worsens with bending over. When the discharge is colored then the infection is most probably bacterial but rarely it may be fungal.
Sinusitis is a term for inflammation of the lining of the sinuses and usually is caused by an allergic reaction of some sort. Common culprits are seasonal pollens, such as grass and ragweed, in addition to dust mites and pet dander. Sinusitis can also be caused by colds (viral), impaired immune systems, and even structural abnormalities of the nose and sinuses.
Risk factors for sinusitis and therefore sinus headaches also include asthma, and chronic pulmonary (lung) problems such as cystic fibrosis.
So what about the migraine debate? How in the world can you tell the difference and know if it is a migraine? Since 40% of all migraines start around the nose and eye it can be a bit confusing. This is made worse by the fact that pseudofed products will treat the nasal congestion that comes with migraine and relieve the headache a bit. But over the long term this is not a good idea as it can increase blood pressure.
Migraines usually are accompanied by light sensitivity unlike the sinus problems. Another clue is the need to lie down in a quiet dark room and not move around. Many times a migraine is only on one side of the head but sometimes it can be both. The specific medications used to treat migraines, such as triptans will not have an effect on a true sinusitis or sinus infection so that too can help diagnose the headache.
Another way to differentiate between the migraines and sinus headaches is through a CT of the sinuses or an MRI. If the results show clear sinuses, then the headaches are most probably migraines.
Treatment for sinus infections should come from a medical provider if the fever is over 100.5F and the symptoms have lasted longer than 10 days. Certain antibiotics can be very effective for sinus infections and allergy treatment responds to lifestyle changes and medications. Don't forget smoking! This makes all types of headaches even worse and increases the risk of infections. Sinus headache may also respond to short term use of decongestants and plenty of fluids. Either way, figuring out which type of headache is present is the best way to treat the problem instead of just taking multiple medications in the hope they will help.
Mary K. Betz, MS RPA-C is a practicing Physician Assistant in neurology who specializes in headache medicine. For more information visit: