Migraines are often mistaken as chronic sinus headaches, and vice versa.

In fact, 90% of self-diagnosed sinus headaches are migraines, but there are some tell-tale signs of a sinus headache that are rarely, if ever, associated with migraines.

Now that we are in the full swing of allergy season, it’s time to take a closer look at the relationship between sinus headaches (caused by allergies and/or an infection) and migraines.  Knowing the difference can save you from taking the wrong medications or spending too much money on incorrect treatments.

What’s the Difference Between Migraine and Sinus Headache?

This is probably the most important question on this topic.  Sometimes, they can feel like the same thing, with initial sinus infection symptoms overlapping with those of a migraine, including:

  • Forehead or facial pain
  • Runny nose
  • Sinus pressure
  • Nasal congestion
  • Sneezing

True sinus headaches are generally due to sinus infections after an allergy attack, and are characterized by more serious symptoms like:

  • Fever
  • Pus in the nasal cavity
  • Foul-smelling breath
  • Difficulty with smell

Without the above symptoms present, it is likely that you have a migraine, which may or may not include additional symptoms like:

  • Aura or prodrome
  • Sensitivity to light and sound
  • Nausea and vomiting
  • Throbbing or pulsating pain

A sinus headache is generally located in a specific area of the head, usually right over the affected sinuses.  Migraines, however, can be trickier.  They can be acute or slow onset, localized to one area or diffuse.  They can even travel from one part of the head to the other.  Your face may hurt, and the migraine could be provoked by any number of triggers, whereas a sinus headache is the result of a viral or bacterial infection.

Understanding Sinus Headaches and Migraines

Literature all over the internet will warn you against not treating your sinus headache.  They tell you all the broad symptoms to watch out for and scare you with threats of mortality.  They remind us that mistaking a sinus headache for a migraine is dangerous because an untreated sinus headache can get worse and migrate to the brain, leading to a central nervous system infection, as well as possibly injuring facial nerves.

Before jumping into the fear wagon, I urge you to consider a few things first:

  1. Look at your personal and family history for migraines, headaches, or chronic sinus infections.
  2. The research (found in sources section below) clearly states that sinus headaches are rare, and are usually accompanied by obvious infection symptoms.
  3. Whenever you think you have a migraine, look for other symptoms and narrow down if it is an infection or a true migraine.

Then, see your provider to discuss your options.

What The Research Tells Us

Research shows that one of the most common misdiagnoses in migraineurs is sinus headache, leading to inadequate treatments and years of continual struggle for the patient.  In fact, most of these sinus headaches are considered “migraines with sinus symptoms.”  That is definitely not the same thing.

Ask yourself a few questions to figure out if you have a migraine with sinus symptoms, or a real sinus headache:

  • Do you have a fever?
  • Are you known to have allergies or asthma, especially this time of year?
  • How disabling are your headaches, particularly over the last 3 months (springtime)?
  • Do your headaches interfere with your ability to function?
  • Do you experience nausea or an aura?
  • Are you sensitive to light? Is your pain pulsating or throbbing?

Essentially, you need a medical professional to confirm your diagnosis.  It really is dangerous to diagnose yourself and treat at home, especially if symptoms are severe enough to be debilitating; however, don’t always believe the fear-mongering articles that threaten death by infection at the smallest sign.  It’s best to get medical advice from your provider and determine the appropriate diagnosis and treatment plan that is as unique as your condition.  Could it be that your allergies are a trigger to your migraine, rather than a trigger to a serious infection and sinus headache?  Food for thought.


  1. www.americanmigrainefoundation.org/understanding-migraine/sinus-headaches/
  2. www.mhni.com/headache-pain-faq/sinus-headache


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