Ask The Doctor

Sinus vs. Migraine Headaches

Dear Dr. Garner,

I get the worst sinus headaches lately. I went to my doctor last week, and he thinks they may be migraines and not sinus headaches.

Is there any way to tell the difference? I am in so much pain. I don’t care what kind of headache it is; I just need to get relief.

My mother also had the same type of headaches when she was younger.

Headaches in Hollis


Dear Headaches,

Thank you for your question. I am sorry you are having such severe headaches. It is interesting that you pose this question. It seems that many people are treated for sinus headaches when, in fact, they have migraines. The method of treatment is much different for each and will have no effect on the other.

More than 90 percent of people who think they have a sinus headache, with symptoms such as pain, stuffy nose with discharge, fever and watery eyes, actually have a migraine.

Sinus headaches occur when the tissues that line the sinuses become swollen and inflamed. This can cause severe pain which overlies the eyes, cheeks and forehead (the areas of the skull where the sinuses are located).

Sinus Symptoms

Symptoms of a sinus headache include fever, pain that gets worse when you bend down, stuffed nose, cough, pain in the upper teeth, nasal discharge, which is usually greenish in color and severe headaches that tend to recur.

With a migraine headache, the blood vessels in the skull become bigger when certain chemicals are formed. As the blood vessels get bigger, they press on the surrounding tissue and cause severe headaches.

Migraine headaches may be accompanied by symptoms such as nausea and vomiting (not usually found with sinus headaches) and sensitivity to sound and light. The pain is intense and throbbing and usually involves one side of the face.

They often start in the morning hours and occur more commonly in women. They may be brought on by a hormone imbalance in women.

Most people with the condition have a family history of migraines.

Migraine Triggers

Triggers, or things that can bring on a migraine headache, include alcohol (usually red wine), food that contains monosodium glutamate (MSG), weather changes, stress and bright lights.

Sometimes there is something known as an aura that occurs before the headache starts. The person about to get the migraine may detect it. This includes certain smells, numbness, seeing flashing lights or experiencing a funny taste in the mouth.

Getting back to your question, how can someone distinguish between migraine and sinus headaches? Pain and pressure in the sinuses, nasal congestion and watery eyes often occur with both migraine and sinus headaches.

To help determine if you have a migraine, consider the following three symptoms: moderate to severe headaches that recur, nausea and sensitivity to light.

If you have two of the above three, you most likely have a migraine headache.

A true sinus headache is rare and usually occurs with a sinus infection. Most people will have fever and thick green nasal secretions. A sinus headache should go away with treatment of the sinus infection.

It is best to see your doctor to determine the type of headache you have. Your doctor has medication to prevent and lessen the pain of migraines. The medication you would take for sinus headaches is not effective against migraines.

Let me know of your progress.

Another word on the topic of a recent column. I urge all men to carefully and thoroughly discuss with their doctor the need for testosterone. This medication is not without harmful effects. Two recent articles in the Feb. 4, 2014 issue of The New York Times highlight some of the dangers and problems with the medication. Be careful.

[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.

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