Migraines vs Sinus Headaches and the Role of Allergies

woman with sinus drainage and migraine headache
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How are allergies and migraine headaches related? What is the difference between sinus headaches and migraines? You may be surprised to learn that most headaches which are self-diagnosed as sinus headaches are actually migraines.


Migraine headache is a chronic condition affecting approximately 6 percent of men and 18 percent of women. Symptoms can be severe, disrupt daily activities, require bed rest, and potentially last for days. The cause of migraines is not completely understood, although is thought to be related to chemicals in the body that cause blood vessels in the brain to dilate, which can lead to the headaches. (Learn more about the signs and symptoms of migraine headaches.)

Signs and Symptoms

The International Headache Society (IHS) defines migraine headaches as the following:

  • Headache attacks that last at least four hours to three days at a time
  • Headaches with at least two of the following qualities:
    • One-sided pain
    • Pulsating quality
    • Moderate to severe symptoms affecting daily activities
    • Symptoms increased with physical activity
  • One of the following symptoms with the headache attacks
    • Nausea or vomiting
    • Sensitivity to sound
    • Sensitivity to light
  • At least five headaches with the above criteria have occurred

The Difference Between Migraines and Sinus Headaches

The International Headache Society (IHS) defines sinus headaches as the following:

  • Colored nasal discharge (green or yellow discharge which is usually thick)
  • Abnormal x-rays (or CAT scan) of the sinuses
  • Symptoms of sinusitis and headaches over the involved sinuses
  • Disappearance of the headache after treatment for sinusitis
  • Sinus headaches usually last five days or longer whereas migraine headaches usually last three days or less

So, sinus headaches, according to the IHS, relate to sinusitis. Yet most diagnoses of “sinus headaches” do not appear to be related to sinusitis. It is, therefore, possible that these “sinus headaches” are in fact migraine headaches.

Studies now tell us that up to 90 percent of "sinus headaches" are actually migraines. Unfortunately, many people are still treated as though their headaches were sinus headaches, with treatments that may or may not be at all effective.

Overlap of Symptoms of Migraines and Allergic Rhinitis

When looking at the numbers above it may seem obvious that there is a difference between sinus headaches, seasonal allergy symptoms, and migraines, but it is not always clear where the distinction lies. This is because there is a significant overlap in the symptoms. For example, both allergic rhinitis and migraines can cause nasal congestion, pain between the eyes which worsens with leaning forward, runny eyes, and a worsening of symptoms with a change in weather or seasons.

How Could Allergies and Migraines Be Related?

Allergic rhinitis (hayfever symptoms) may often lead to what is called a “sinus headache." An allergic reaction leads to the release of histamine, which can also lead to the dilation of blood vessels in the brain, and therefore cause or worsen a migraine headache.

Do People With Allergies Suffer More Migraines?

In at least one study it has been found that people with allergies suffer more migraines. People with allergic rhinitis were found to meet the criteria for having migraine headaches far more likely than people without allergic rhinitis. In fact, those with allergies were approximately 14 times more likely to report migraine headaches compared to those without allergies.

Other studies show an association between migraine headaches and allergic asthma, and that the occurrence of migraines in children with atopic disease is increased. (Atopic diseases are those in which there is an increased sensitivity to external irritants and includes allergic rhinitis, asthma, and allergic eczema.) Furthermore, approximately 40 percent of children with migraine headaches show the presence of allergies through allergy testing.

How Do Allergies Affect People With Migraines?

Not only do allergies appear to increase the likelihood that a person may suffer from migraines, but people with migraines that have allergic triggers appear to have more severe and disabling migraines. For this reason alone it appears to make sense that allergies be treated aggressively. A theory that may help to explain this has to do with the nerve supply of the face. The trigeminal nerve has nerve endings in the nasal passages and sinuses. It's thought that perhaps this nerve becomes hypersensitized as it transmits pain messages to the brain.

Do Food Allergies Cause or Worsen Migraine Headaches?

There is much controversy in the area of food allergies related to migraines. While some experts believe that foods can worsen migraines through an allergic process, others believe the trigger is a result of food intolerance. It is possible that migraines are triggered by both allergic and non-allergic reactions to foods.

Does Treatment of Allergies Help Migraine Headaches?

Most studies using antihistamines for the treatment and prevention of migraine headaches do not show that these medications are helpful. It has, however, been suggested that the aggressive treatment of allergic rhinitis, for example with nasal sprays and allergy shots, may help treat and prevent headaches in those people who appear to have allergic triggers to their migraines. In at least one study, allergy shots were found to decrease the severity and disability of migraine headaches in younger patients.

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Article Sources
  • Aupiasis, C., Wanin, S., Romanello, S. et al. Association Between Migraine and Atopic Diseases in Childhood: A Potential Protective Role of Anti-Allergic Drugs. Headache. 2017. 57(4):612-624.
  • Gryglas, A. Allergic Rhinitis and Chronic Daily Headaches: Is There a Link?. Current Neurology and Neuroscience Reports. 2016. 16(4):33.