Differentiating a Migraine from a Sinus Infection

Clues to Differentiate Sinusitis from a Migraine Attack

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Do you feel pressure in your forehead or temple? Do you also have "cold symptoms" like a runny nose? Were you shocked when your doctor suggested this could be a migraine, and not a sinus infection?

Sinus Infection versus Migraine

Too often doctors prescribe antibiotics or nasal steroid sprays for a sinus infection that is really a migraine. This was revealed in an older study in the Archives of Internal Medicine. Scientists in this study examined nearly 3000 patients who had no prior diagnosis of migraines. These patients either self-diagnosed or were diagnosed by their doctors as having a sinus headache. The study found that the majority of patients, over 80 percent, actually met criteria for a migraine-type headache, according to the International Headache Society.

In another study in Headache, 63 percent of patients who self-diagnosed themselves as having a sinus headache actually met criteria as having migraine with or without aura. Only 3 percent were found to have a headache attributed to sinusitis.

These findings are eye-opening. Let's take a closer look at how to best distinguish these two unique medical conditions

Clues That Favor Sinus Infection Over a Migraine

  • Fever: You should not have a fever with a migraine, but this can be seen in sinusitis, especially if the sinus infection is caused by bacteria, requiring an antibiotic for treatment.
  • Purulent nasal discharge: While it is not infrequent to have a congested or runny nose with a migraine, you will not have prolonged, thick, yellowish/green discharge from your nose. This is more likely to be seen in sinusitis.
  • Ear pain/tooth pain: Ear and tooth pain are common complaints in those suffering from a sinus infection.

Clues That Favor Migraine Over a Sinus Infection

  • Nausea and vomiting
  • Sensitivity to light (photophobia)
  • Sensitivity to sound (phonophobia)

Do Not Be Fooled

  • Migraineurs often report headache triggers that are common triggers of rhinosinusitis like: weather changes, seasonal change, and allergen exposure.
  • Also, both sinus headaches and migraines can occur on both side of the head (bilaterally) or one side of the head (unilaterally). Although, migraines are more commonly unilateral.
  • Also, similar to sinus pain, migraineurs can have pain in their maxillary or cheek areas.

Bottom Line

So the take home message here is that yes, unfortunately, migraines are frequently misdiagnosed as sinusitis. This means that too often doctors prescribe antibiotics for sinus infections that are really migraines. What can you do about it? Let's summarize below:

  • A thorough history and examination by a doctor is critical to making an accurate diagnosis. The treatment for a sinus headache versus a migraine is very different. You do not want to waste your time or risk your health by being treated for the wrong condition.
  • If you find yourself getting treated for sinus infections multiple times a year, ask your doctor about the possibility of having migraines.
  • Whether you have sinus headaches or migraines or both, understanding your diagnosis and treatment plan is important for your overall quality of life. Be proactive in your healthcare.
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Article Sources
  • Chow, A.W., Benninger, M.S., Brook, I., Brozek, J.L., Goldstein, E.J.C., Hicks, L.A. et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis. in Children and Adults.
  • Eross, E., Dodick, D., & Eross, M. (2007). The sinus, allergy and migraine study. Headache, 47:213–24.
  • Gwaltney, J.M., Wiesinger, B.A., Patrie, J.T. (2004). Acute community-acquired bacterial sinusitis: the value of antimicrobial treatment ans the natural history. Clinical Infectious Diseases, 38:227-33.
  • Schreiber, C.P., Hutchinson, S. Webster, C.J., Ames, M., Richardson, M.S., Power, C. (2004). Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Archives Internal Medicine, Sep;164(16):1769-72.