It starts as a dull pressure behind your eyes and across your cheeks. Your nose feels a little blocked, bending forward makes it worse, and the obvious conclusion is that your sinuses are to blame.
So you reach for a decongestant, maybe another round of antibiotics, and wait for it to clear. Except it keeps coming back.
If this sounds familiar, you are far from alone. A large study published in the Archives of Internal Medicine screened 2,991 people with a history of self-described or doctor-diagnosed sinus headache and found that 88 percent actually met the criteria for migraine.
That means the vast majority of people treating their sinuses may be treating the wrong problem. Here is what a sinus headache really is, what is more likely going on, and how to tell the difference.
What Is a True Sinus Headache?
A genuine sinus headache is caused by inflammation or infection of the sinuses, known as rhinosinusitis. The sinuses are air-filled spaces behind your cheekbones, forehead and nose. When they become infected and blocked, pressure builds and pain follows.
Under international headache classification guidelines, a headache is only attributed to the sinuses when there is clear evidence of rhinosinusitis. That usually means symptoms such as:
- Thick, discoloured (yellow or green) nasal discharge
- Fever or feeling generally unwell
- A reduced sense of smell
- Pain that improves as the infection clears
True sinus headaches tend to follow a cold or infection and settle once it resolves. They are not usually recurring episodes that come and go for months or years without signs of infection.
Why Migraine Is So Often Mistaken for Sinus Pain
Migraine is not always a one-sided, throbbing headache with visual disturbances. For many people, it shows up as pressure across the forehead, cheeks and around the eyes, exactly where most people expect sinus pain to sit.
Migraine can also activate the nerves that supply the face and nasal passages, which is why some people notice a runny or blocked nose, watery eyes, or facial fullness during an attack. These symptoms feel like sinus trouble, but they are part of the migraine process rather than an infection.
Common triggers add to the confusion. Changes in weather, air pressure and seasonal allergies can bring on migraine in some people, so it is easy to link the headache to your sinuses when the timing seems to line up.
Other Headaches That Masquerade as Sinus Pain
Migraine is the most common culprit, but it is not the only one. Other headache types can produce pain in the face and forehead too:
- Tension-type headache: a steady, band-like pressure across the forehead that is often linked to stress, posture and tight muscles.
- Cervicogenic headache: pain that starts in the upper neck and refers forward into the head, sometimes reaching the forehead and behind the eyes.
- Headache behind the eyes: a common complaint with several possible causes, including migraine and neck-related headache.
This is why recurring “sinus” pain deserves a proper look, rather than another round of guesswork.
How to Tell the Difference
No checklist replaces a proper assessment, but these patterns can help you decide whether your sinuses are really the cause:
- Your headache comes back regularly without any sign of a cold or infection
- Nasal discharge, if any, is clear and watery rather than thick and coloured
- Light, sound or smells bother you during an episode
- You feel nauseous, or want to lie down in a dark, quiet room
- Decongestants and antibiotics have made little lasting difference
- The pain settles within hours to a few days, then returns weeks later
If several of these sound familiar, migraine or another headache type is a much more likely explanation than your sinuses.
Please speak with your GP straight away if you have a high fever, swelling around the eyes, changes to your vision, confusion, a stiff neck, or a sudden, severe headache unlike any you have had before. These symptoms need prompt medical review.
How Sydney Headache & Migraine Centre Can Help
Many people who come to us have spent years treating their sinuses with limited success. By the time they arrive, they are understandably frustrated and unsure what to try next.
Our practitioners are trained in the Watson Headache® Approach, a hands-on assessment that looks at whether the upper neck is contributing to your headache or migraine. The upper neck and the nerves that supply the face and head are closely connected, which is one reason pain from this area can be felt in the forehead, behind the eyes and across the face.
We take the time to understand your full history, including what you have already tried, so your care is based on what we actually find rather than assumptions. Research on the Watson Headache® Approach has reported a positive response in 80 percent of patients, although every person is different and results vary.
If your “sinus headaches” keep coming back, it may be time to find out what is really going on.
At Sydney Headache & Migraine Centre, we take the time to listen to your story and work through every avenue toward a positive outcome.
Frequently Asked Questions
Can a migraine feel like sinus pressure?
Yes. Migraine commonly causes pressure across the forehead, cheeks and around the eyes, and can also trigger a blocked or runny nose, which is why it is so often mistaken for sinus trouble.
How do I know if my headache is from my sinuses?
True sinus headaches usually come with signs of infection, such as thick coloured nasal discharge, fever and a reduced sense of smell, and they ease as the infection clears.
Why do my sinus headaches keep coming back?
Recurring episodes without signs of infection are more likely to be migraine or another headache type. A proper assessment can help identify the real cause.
Do antibiotics help sinus headaches?
Antibiotics only help bacterial sinus infections. If your headache is caused by migraine or a neck-related problem, antibiotics will not address it.
Can weather changes cause sinus headaches?
Changes in weather and air pressure are commonly reported migraine triggers, which can make migraine feel like a sinus problem when the timing lines up.
Article reviewed by: Rob Wallis, B App Sc (Phys) M.A.P.A.
Watson Headache® Certified Practitioner & Facilitator (Level 4).
Stat Sources
- “The majority (88%) of these patients with a history of self-described or physician-diagnosed ‘sinus’ headache were diagnosed… as fulfilling IHS migraine criteria.” Schreiber CP et al., Prevalence of Migraine in Patients With a History of Self-reported or Physician-Diagnosed “Sinus” Headache, Archives of Internal Medicine (2004).
- Watson Headache® Approach 80 percent positive response rate
Book A Migraine / Headache Assessment
Book online or give us a call on 1300MyHeadache to organise an assessment with Sydney Headache & Migraine Centre and learn more about what causes your migraines and how we can help treat them.
