Sinus Headache vs Migraine: How to Tell and What Helps
Why most self-diagnosed sinus headaches turn out to be migraine, how to tell them apart, and what actually helps each.
Part of our Sinusitis condition guide.
Key fact: When researchers have taken people who believed they had sinus headaches and applied formal diagnostic criteria, the large majority met the criteria for migraine instead. This is one of the most common misattributions in everyday medicine—and it matters, because the two need entirely different treatment.
Get Sinus Symptoms Assessed Online
Access Doctor is a UK online doctor and GPhC-registered pharmacy. Where facial pain is genuinely sinus-related, a pharmacist independent prescriber can assess and treat it without a GP appointment. Where it's not, we'll say so.
View Sinusitis Treatments →Why the two get confused
"Sinus headache" is one of the most frequently self-diagnosed conditions in the UK—and one of the least frequently correct.
The confusion is entirely understandable. Migraine pain is often felt across the forehead and behind the eyes, exactly where the sinuses are. Migraine attacks are commonly triggered by weather changes, which people reasonably associate with sinus problems. And critically, migraine can produce genuine, objective nasal symptoms: a blocked nose, a runny nose and watering eyes.
So someone gets a headache over their cheeks with a blocked nose, concludes it's their sinuses, takes a decongestant, and the attack eventually resolves—as migraine attacks do. The theory appears confirmed. The cycle can continue for years.
Majority
of self-diagnosed sinus headaches meet migraine criteria
4–72 hrs
typical untreated migraine attack duration
2–3 wks
duration of a genuine acute sinus episode
How migraine produces nasal symptoms
This is the piece that makes the whole thing make sense, and it's worth understanding because it explains why the nasal symptoms are real rather than imagined.
The trigeminal nerve carries sensation from the face and is central to how migraine generates pain. When the trigeminal system is activated during an attack, it can trigger autonomic responses through what is called the trigeminal autonomic reflex.
Those responses include dilation of blood vessels in the nasal lining, increased mucus production and increased tear production—typically on the same side as the headache. The result is a genuinely blocked nose, a genuinely runny nose and genuinely watering eyes, occurring as part of a migraine attack.
So the nasal symptoms are not a red herring—they are a real feature of migraine. This is why "but my nose really was blocked" doesn't settle the question. The distinguishing information is elsewhere: in the pattern over time, and in whether there is any evidence of actual infection.
Side-by-side comparison
| Feature | Genuine sinus headache | Migraine |
|---|---|---|
| Pattern | One episode, with an infection | Recurrent attacks over months or years |
| Between episodes | Part of a single illness | Completely well between attacks |
| Follows a cold? | Usually yes | No |
| Nasal discharge | Thick, often discoloured | Clear and watery, or none |
| Sense of smell | Reduced or absent | Normal—often heightened sensitivity to smells |
| Pain character | Pressure, heaviness, fullness | Throbbing or pulsating |
| Sides affected | Often both | Often one-sided |
| Nausea or vomiting | Uncommon | Common |
| Light and sound sensitivity | Uncommon | Common and often marked |
| Effect of movement | Worse bending forward | Worse with any routine activity |
| Duration | Days to weeks, with the infection | 4 to 72 hours per attack |
| Fever | Possible | No |
| Response to antibiotics | Possible, if bacterial | None |
The three-question self-check
1
Does this keep happening?
Recurrent headache attacks over months, with completely well periods in between, points strongly to migraine. Genuine sinus headache is part of a single infective illness that resolves and doesn't return next month.
2
Is there evidence of an actual infection?
Thick discoloured discharge, a reduced sense of smell, a recent cold, possibly fever. Without these, there is little reason to think the sinuses are infected at all.
3
Do you get nausea, or light and sound sensitivity?
Wanting a dark quiet room, feeling sick, or finding normal activity makes the pain worse are classic migraine features and are uncommon in sinusitis.
| Your pattern | More likely | Next step |
|---|---|---|
| One episode, after a cold, blocked nose, lost smell | Sinusitis | Sinusitis self-care, then assessment at day 10 |
| Recurrent attacks, well in between, nausea or light sensitivity | Migraine | See a GP about migraine management |
| Recurrent attacks with nasal symptoms only during them | Migraine | See a GP. The nasal symptoms are part of the attack |
| Constant daily pressure for months, blocked nose, lost smell | Chronic sinusitis | See acute vs chronic sinusitis |
| Repeated sinus treatments that never helped | Diagnosis needs revisiting | See a GP |
What a genuine sinus headache looks like
Headache attributed to rhinosinusitis is a real diagnosis, but formally it requires evidence of actual rhinosinusitis—not just pain in the region of the sinuses.
- Occurs alongside an active sinus infection, with nasal blockage and discharge
- Reduced or absent sense of smell—one of the more specific signs
- Usually follows a cold by a few days
- Pain is pressure-like over the cheeks or forehead rather than throbbing
- Worse on bending forward or lying down
- Improves as the infection resolves, and doesn't return the following month
- Often both sides, matching which sinuses are affected
If your headache fits this and is part of a current sinus episode, our guides on relieving sinus pressure and whether it is bacterial or viral are the relevant next reads.
What points to migraine
Recurrence
Attacks that come and go over months or years, with complete recovery in between. The single strongest clue.
Throbbing, often one-sided
A pulsating quality rather than steady pressure, frequently confined to one side.
Nausea
Feeling sick, or actually vomiting, during attacks.
Light and sound sensitivity
Wanting a dark, quiet room. Uncommon in sinusitis.
Worse with activity
Climbing stairs or bending makes it noticeably worse, so you avoid moving.
Identifiable triggers
Weather, hormones, missed meals, poor sleep, stress or specific foods.
Aura—visual disturbances such as zigzag lines or blind spots before the headache—occurs in a minority and effectively settles the question when present. If this picture fits, our migraine condition guide is the better starting point.
Other causes of facial pain
- Tension-type headache—a band-like pressure around the head, without nasal symptoms or nausea
- Cluster headache—severe one-sided pain around one eye with tearing, a red eye and nasal blockage on that side, in bouts. Frequently mistaken for sinus problems.
- Dental infection—an upper tooth root abscess can cause one-sided facial pain and genuine maxillary sinusitis
- Temporomandibular joint problems—jaw joint pain radiating across the face, often with clicking
- Trigeminal neuralgia—brief, electric-shock-like facial pain triggered by touch, chewing or cold air
- Medication overuse headache—from frequent painkiller use, and a genuinely common cause of daily headache
Medication overuse headache deserves a mention here because it develops so easily. Taking painkillers for headaches on more than about 10 to 15 days a month can itself cause a persistent daily headache. People treating frequent "sinus headaches" with regular painkillers are exactly the group at risk.
What helps genuine sinus headache
If the pain is genuinely from a sinus infection, treat the sinusitis and the headache follows.
- Saline nasal irrigation—the best-evidenced home measure
- Regular pain relief at full dose on a schedule
- Warm compress over the face
- Sleep propped up to help overnight drainage
- Steroid nasal spray if symptoms persist past 10 days—Access Doctor supplies mometasone nasal spray for sinusitis and beclometasone nasal spray for sinusitis
- Antibiotics only where bacterial infection is genuinely likely, such as phenoxymethylpenicillin for sinusitis
What helps migraine
Migraine is managed quite differently, and this is a GP conversation rather than something to self-treat indefinitely.
- Treat attacks early—simple painkillers work far better taken at the first sign than once the attack is established
- Anti-sickness medicines can help both the nausea and the absorption of painkillers
- Triptans—migraine-specific treatments available on prescription for attacks that don't respond to simple analgesia
- Preventive treatment—considered where attacks are frequent
- Trigger identification through a diary
- Limit painkiller days to avoid medication overuse headache
Crucially, none of this happens if the problem is still labelled as sinus trouble. Getting the diagnosis right is what unlocks effective treatment. See our migraine condition guide.
Keep a headache diary
If you're unsure which you have, two to three months of simple records will usually answer it, and it's exactly what a GP needs.
- Date and time each headache started and stopped
- Where the pain was, and whether one side or both
- Pressure or throbbing
- Nausea, light or sound sensitivity
- Any nasal symptoms, and whether they were present between headaches too
- Whether you had a cold at the time
- What you took and whether it helped
- Anything that might have triggered it
The pattern usually declares itself quickly. Discrete attacks with clear well periods and no infection between them is migraine. A single continuous illness with nasal blockage and lost smell is sinusitis. Recollection alone rarely separates these reliably, which is why writing it down works so well.
Get Treatment If Your Symptoms Are Genuinely Sinus-Related
Where facial pain comes with nasal blockage, discoloured discharge and a reduced sense of smell, a GPhC-registered pharmacist independent prescriber can assess and treat it online without a GP appointment. Recurrent headaches without infection need a GP rather than sinus treatment.
Start Sinusitis Consultation →Red flags needing emergency care
Call 999 or go to A&E for a sudden severe headache that reaches maximum intensity within seconds, a headache with fever and neck stiffness or a rash that doesn't fade under a glass, confusion or drowsiness, weakness or numbness down one side, difficulty speaking, a seizure, a headache after a head injury, or swelling and redness around an eye with vision change.
Arrange prompt GP review for a headache that is new and persistent, is progressively worsening, is consistently one-sided in the same place, wakes you from sleep, is worse on coughing or bending, or is new in anyone over 50.
Frequently Asked Questions
Is my sinus headache actually a migraine?
Quite possibly. Studies of people who believed they had sinus headaches have repeatedly found that the large majority actually met the diagnostic criteria for migraine. The confusion happens because migraine can produce genuine nasal symptoms including congestion, a runny nose and watering eyes, through a reflex involving the trigeminal nerve. If your headaches recur regularly without any accompanying infection, migraine is the more likely explanation.
What is the difference between a sinus headache and a migraine?
The most useful difference is pattern rather than location. Genuine sinus headache accompanies an actual sinus infection, so it comes with a blocked nose, thick discharge, reduced sense of smell and usually follows a cold, and it resolves as the infection does. Migraine is recurrent, often one-sided and throbbing, frequently comes with nausea or sensitivity to light and sound, is made worse by movement, and settles between attacks leaving you completely well.
Why does migraine cause a blocked nose and watery eyes?
Through the trigeminal autonomic reflex. The trigeminal nerve carries sensation from the face and is central to migraine, and when it is activated it can trigger autonomic responses in the nose and eyes on the same side. That produces real nasal congestion, a runny nose and tearing, which feel exactly like sinus symptoms. These are genuine physical signs rather than imagination, which is precisely why the misdiagnosis is so common and so persistent.
Can sinusitis cause a headache?
Yes, genuinely. Acute sinusitis commonly causes facial pain and headache, typically felt over the cheeks or forehead, often worse on bending forward. The key is that it comes as part of an infection with other clear signs such as nasal blockage, discoloured discharge and a reduced sense of smell, and it resolves as the sinusitis clears. What sinusitis does not usually cause is recurring headaches over months in someone whose nose is otherwise normal.
Does chronic sinusitis cause recurring headaches?
Less often than people assume. Chronic sinusitis tends to cause a constant dull facial pressure rather than discrete headache attacks, and its dominant symptoms are usually nasal blockage and loss of smell. Recurring headache attacks that come and go, with clear well periods in between, fit migraine far better. If you have been treated repeatedly for sinus headaches without lasting benefit, reconsidering the diagnosis is often more productive than another course of treatment.
Why did my sinus treatment not help my headache?
The most common reason is that the headache was never sinus-related. Repeated antibiotic or decongestant courses that produce no lasting improvement are a strong clue that the diagnosis needs revisiting rather than the treatment repeating. Some people do report temporary relief from decongestants, which reinforces the sinus theory, but that can reflect the natural resolution of a migraine attack rather than the medicine working.
When should I see a doctor about facial pain or headache?
See a GP if headaches are recurring regularly, are affecting your daily life, or if treatments aimed at your sinuses have not helped, since the diagnosis may need revisiting. Seek emergency care immediately for a sudden severe headache reaching maximum intensity within seconds, a headache with fever and neck stiffness, confusion, weakness, changes in vision, or swelling around an eye. These require urgent assessment regardless of any previous diagnosis.
Completing the treatment
Where facial pain is genuinely sinus-related, Access Doctor supplies steroid nasal sprays and, for the minority with bacterial infection, antibiotics—after a short online consultation reviewed by a GPhC-registered pharmacist independent prescriber. Where the picture fits migraine instead, a GP is the right route. See the sinusitis range on the sinusitis treatment page.
Steroid spray · Rx
Mometasone Nasal Spray for Sinusitis
For genuine sinus symptoms persisting past day 10.
View product →Steroid spray · Rx
Beclometasone Nasal Spray for Sinusitis
Alternative steroid nasal spray for sinus inflammation.
View product →Antibiotic · Rx
Phenoxymethylpenicillin for Sinusitis
Where a bacterial sinus infection is genuinely likely.
View product →Antibiotic · Rx
Doxycycline Capsules for Sinusitis
Alternative where penicillin cannot be used.
View product →References
- NICE Clinical Knowledge Summaries. Sinusitis. cks.nice.org.uk
- NICE Clinical Knowledge Summaries. Migraine. cks.nice.org.uk
- NICE. Headaches in over 12s: diagnosis and management (CG150). nice.org.uk
- NHS. Migraine. nhs.uk
- NHS. Sinusitis (sinus infection). nhs.uk
- International Headache Society. International Classification of Headache Disorders (ICHD-3). ichd-3.org
- The Migraine Trust. Migraine information and support. migrainetrust.org
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.