Study: Most Sinus Headaches Are Migraines

June 24, 2002 -- Think sinus pain, pressure and congestion are sure signs of a sinus headache? You could be wrong, and the error could be hurting you.

The vast majority of people who believe they are having sinus headaches are actually having migraines, according to new research presented last week at a meeting of the American Headache Society in Seattle.

Closer scrutiny of the 2,524 subjects in the study found that their physician-diagnosed or self-described sinus headaches were migraine-type headaches a full 90 percent of the time.

"People think they have sinus headaches. It's the association of pain in the front of the face and pressure under the eyes," explains Dr. Joel Saper, director of the Michigan Pain and Neurological Institute in Ann Arbor. "It's an innocent misunderstanding."

Adds Dr. Curtis Schreiber, associate director of the Headache Center in Springfield, Mo., who presented the research: "We would find that they had symptoms that involved their sinus or nasal passages, but as they described the rest of their symptoms, they had other features that really led us to think they had migraine underlying all of their symptoms."

Sinus Pain in Migraine

An estimated 28 million Americans suffer from migraine headaches, but only about half of these are ever diagnosed.

Diagnosis of migraines relies upon using a checklist of symptoms that include intensity and type of pain, nausea or vomiting and sensitivity to light or sound.

"We have a kind of an understanding of what migraine is based on a certain set of symptoms," says Schreiber. "But I think that there are a lot of people who have migraines who do not necessarily follow the textbook."

Involvement of the sinuses is not part of the typical list and may lead many physicians to favor a sinus headache diagnosis.

"The way that doctors have been trained to diagnose migraine really does not incorporate any of these sinus-like symptoms," says Schreiber. "We discount those from a diagnostic perspective."

There are also other types of headaches involving the sinuses that are unrelated to migraine, so it may be hard to tell the difference on your own without a doctor's evaluation. But here are a few distinguishing features:

A major culprit of true sinus headache is sinus infection, which will generally involve yellow, green or dirty gray discharge, fever, and will last from seven to 10 days.

People with self-described sinus headaches who are actually experiencing migraine generally will have sinus pain, congestion and headaches, but these symptoms will usually resolve within two to three days and are not accompanied by fever or discharge.

Proper Diagnosis, Proper Treatment

The proper diagnosis of headache pain is important because it ensures proper treatment. Treating sinus headaches that are actually migraines with over-the-counter sinus medications can confuse this process.

"The over-the-counter medicines do contain ingredients that can help migraine — painkillers like aspirin or acetaminophen and decongestants," says Saper. But he warns these treatments may offer migraine sufferers no real, lasting relief for their pain.

In the end, some may be driven to seek inappropriate surgical treatments for their perceived chronic sinus pain. "If they know they have migraine, they will know which way to go and get help," he says.

Headache suffers may benefit either way from the use of migraine medications. In a separate study presented at the American Headache Society Meeting, Schreiber reports that those with perceived sinus headaches obtained pain relief when they were treated with the migraine drug sumatriptan.

"The issue here isn't necessarily that every individual that has sinus headaches should take a migraine pill," says Schreiber. "The idea here is trying to get people to understand that this can be one of the ways that migraine shows up. We're trying to expand the checklist so that people incorporate other symptoms."