Have you ever suddenly felt a throbbing pain in your sinuses when you bent forward? Maybe you gradually start to notice a feeling of pressure in your face as well. The pain starts spreading to the rest of your head. Perhaps your nose even begins to run.
As the discomfort in your face and head intensifies, your first thought may be to try to treat it with sinus medication. But what happens if that doesn't help?
Sinus discomfort and head pain typically accompany viral infections like the flu or conditions such as allergies. But if pain worsens or persists, is it really a sinus headache…or possibly something else?
When people feel head pain originating in the sinus area, it’s common for them to believe they’re experiencing sinusitis (sinus headache). But could it actually be an untreated migraine?
More than just a bad headache, migraine affects 1 billion people worldwide, including 39 million Americans. But migraines are often misdiagnosed and undertreated. The International Headache Society (IHS) suggests that many people who believe they’re experiencing sinus headache may actually meet IHS criteria for migraine. For example, a study of nearly 3000 people who visited their primary care physician complaining of sinus headache found that 88% were ultimately diagnosed with migraine instead.
Migraine can initially be mistaken for sinusitis because the two can have similar symptoms and risk factors:
Both sinus headaches and migraines can manifest with facial pain and pressure on forehead and cheeks. A runny or stuffy nose, and watery eyes due to nasal congestion — common in sinus headaches — affects 45% of people having a migraine as well, says the American Migraine Foundation. Symptoms are reported to be worse in the mornings and when bending forward.
Migraine without aura — that is, not preceded by visual or other sensory disturbances — is often mistaken for a sinus headache.
When a bacterial sinus infection becomes acute, headache may be accompanied by fever, a thick yellowish discharge, and a reduced sense of smell.
On the other hand, migraine symptoms may include nausea/vomiting, sensitivity to light and/or sound, aversion to strong smells, dizziness, blurred vision, and fatigue. Nasal congestion, if any, is usually clear and runny.
Another difference between sinus headache and migraine is the location of pain. While migraine may be felt in various places (such as the temples, high in the forehead, back of the head, behind one eye only), sinus pain is primarily focused in the face. And migraine usually occurs on one side of the head; sinus, on both.
Also, migraine pain is frequently described as throbbing or pulsing, while sinusitis is reported as pressure pain.
The flu or seasonal allergies can foster viral or bacterial infection of the sinuses, causing swelling of the sinus passages and sinus congestion. The blockage creates pressure pain behind cheeks, nose, and eyes, leading to headache.
Other factors may also induce sinusitis: for example, nasal polyps (abnormal growths in the nose or sinuses) or deviated septum (when the line of cartilage and bone down the center of the nose isn’t straight). These conditions can block or prevent proper mucus drainage from sinuses, causing congestion.
Interestingly, like migraine, sinus risk factors can include a previous history or family history of migraine and headaches associated with hormonal changes.
Migraine is genetic — it tends to run in families. Also, women who get their period are 3 times more likely than men to have a migraine due to monthly hormonal changes. People with allergies are 10 times more likely than others to get migraines.
A migraine can be triggered by a variety of factors unique to each person and potentially including:
Self-diagnosis can be tricky, especially when you’re currently in pain. It’s always best to consult a healthcare provider for an accurate determination and to assure that you get appropriate treatment. If you have no facial pain, and you’ve experienced this type of head pain before, ask yourself these questions, then report your symptoms accurately to your medical professional for a clear diagnosis:
If you answered ‘Yes’ to at least 2 of these 3 three questions, you may be experiencing a migraine.
Journal your symptoms — your notes can help your doctor determine if you’re experiencing sinusitis, or if it may actually be migraine. Journaling might also help you uncover potential triggers of your head pain. Note the day and time of your headaches, your surroundings, foods and drinks you consumed, and any activities before your pain started.
You can potentially avoid infections through good hand hygiene (wash hands frequently!) and a healthy lifestyle, and by carefully managing sinusitis triggers, such as allergies.
If your doctor determines that you have a sinus headache, treatment may focus on decreasing inflammation and draining mucus to relieve pressure and pain. Warm compresses can help with pain; warm, moist air from a vaporizer or inhaler may help with congestion. Saline nasal spray and nasal drops can also work to thin mucus and ease drainage.
Medications for sinusitis include decongestants, analgesics, and antihistamines. Alternatively, an over-the-counter bioelectric device can be used to emit micro-current waveforms, which target blood vessels and offer nerve relief.
If a sinus headache lasts longer than 7-10 days, it is more likely caused by bacteria, and your doctor may prescribe antibiotics. If pain continues after a course of antibiotics, your doctor will continue to develop a diagnosis.
Conditions such as a deviated septum or nasal polyps may call for surgery if they are a continuous irritant.
You may have heard that the best treatment for a migraine headache is to prevent one from happening. But that’s not always easy.
Some potentially useful preventative measures: get regular and adequate sleep, maintain a nutritious diet, and stay well-hydrated. Use your migraine journal to understand and manage your migraine triggers.
If you’re diagnosed with acute migraine, you may find some relief with over-the-counter (OTC) painkillers, cold compresses, rest, and relaxation techniques like meditation. Or your doctor can prescribe an appropriate medication to help.
If you experience chronic migraine (more than 15 attacks per month), your medical professional will likely prescribe preventive medication — for example, CGRP inhibitors, which help blood vessels dilate and are often shown more effective than traditional medications at preventing chronic episodes.
Consult a medical professional if your sinus-related headaches become more frequent or severe, if OTC medications aren’t working, or if your sinus head pain is interfering with daily activities. If your sinus headaches haven’t responded to standard medication, ask your physician if a migraine-specific treatment may be right for you.
Using your unique DNA profile, the Mable team can work with you to help reduce the frequency and severity of your head pain. We offer streamlined migraine diagnosis and treatment assisted by world-leading experts in migraine care. Our headache specialists help tailor your DNA-guided migraine treatment plan, based on the latest evidence and clinical practice.
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