I have sinus headaches… could it be migraine?
Patients with migraine are often falsely diagnosed as having sinus headache or “sinusitis”.
Can a sinusitis cause a headache?
YES. A true sinusitis can cause severe headaches, sometimes associated with facial tenderness when the areas over the sinuses are touched or when the person bends over.
How common is it to have a diagnosis of sinusitis when in the end the problem is really migraine?
Research has shown that three quarters (75%) of headaches thought to be “sinus headaches” are actually migraine, which is important because the treatment of sinusitis and migraine is completely different.
Of course, it is also possible for a person with migraine to have a true bacterial sinusitis, but usually the headache will feel quite different from the usual migraine.
How can we make the difference between a sinusitis and migraine?
- A migraine will usually resolve in 24 to 48 hours while sinusitis usually requires treatment with antibiotics.
- Migraine attacks often recur on a regular basis. It is very rare to have many episodes of bacterial sinusitis every year.
- Acute sinusitis is caused by an infection of the sinuses and is usually associated with other symptoms, such as colored nasal drainage, fever, post nasal drip in the back of the throat.
Is it possible for sinus inflammation to trigger migraine?
The migrainous brain is sensitive to external stimuli. Patients having migraines with sinusal symptoms (nasal congestion, allergies, pain in the sinus area) may also have migraines that are triggered by sinus irritation to start with.
Is it possible for a migraine to cause symptoms in the sinuses?
Yes. Migraine is caused by an inflammatory soup being released around sensitive structure inside the skull (meninges and arteries). But if the inflammation goes to the nerves of the sinuses, it could in theory cause symptoms and pain there too.
This two-way relationship between the migraine brain and another head zone is a common example of the Ping Pong theory. (See this post)
In summary, if you think you have recurrent sinus headaches, you may actually have migraine. It is important to discuss your symptoms with your doctor to get the right treatment.
Eross E, Dodick D, Eross M. The Sinus, Allergy and Migraine Study (SAMS). Headache. 2007;47(2):213-24.