The Sinus Headache Mistake: Migraine or Sinus Headache?

“Sinus Headaches”: One of the true mysteries of clinical medicine

Patients regularly come into our offices complaining of pain in the area around their eyes. This pain usually also circles around their forehead and, without fail, these patients always ask for antibiotics to make the pain go away. However, all too often antibiotics are prescribed for sinus headaches that are not caused by a sinus infection. It is for this reason that we make sure we always carry out a careful history check when treating patients who complain of a sinus headache. This may all sound a little confusing, but let us explain.

True Sinus Infections

The main symptom of a true bacterial sinus infection tends to be pressure over a particular sinus area: this can commonly take place over the cheeks or sometimes behind the bridge of the nose, close to the eyes. A true sinus infection is usually preceded by symptoms such as a low-grade fever and the subsequent development of mucus discharge. This discharge can be filled with various colors ranging from white, yellow or green pus.

Another useful finding is that if a patient with a true sinus infection bends their head forward and downward the pain and pressure will be exacerbated by gravity. Symptoms of a bacterial sinus infection can also include bad breath, as many types of organisms are anaerobic. This means they don”t need oxygen to replicate and, as a result, give off a bad smell.

Headache Guidelines

The International Headache Society has previously published guidelines regarding the classification of headaches. These guidelines state that the recurrence of headaches in this population is not a sinus headache, but should be classified as a form of a migraine headache.

A large study in the Archives of Internal Medicine in 2004, showed that most patients complaining of sinus headaches actually had migraines. This confusion is understandable as 84% of these patients had symptoms of sinus pressure, 82% had sinus pain and 63% had nasal congestion. The old adage: “if it walks like a duck and squawks like a duck, then it must be a duck” seems to apply here. However, symptoms in migraine patients are actually due to the swelling of blood vessels and not due to an infection.

Our Own Experience

From our own perspective, our very own Dr. Dean used to get occasional migraines as a teenager. He has described it as being an awful experience that used to come on in a very surreal way. If he looked in the mirror he would only be able to see half of his face and body. This was due to a spasm of the eye blood vessel. Next, nausea would start which usually led to vomiting, and then the big booming headache would set in.

The migraine variant, or what is commonly called the sinus headache, is more subtle in how it presents itself. There is no temporary visual loss and the feeling of nausea is less common, but a headache is real and painful! There are also symptoms of nasal congestion and eye tearing, so a person may think they are even having an allergy sinus attack.

A migraine vs. Sinus Infection

Differentiating between a migraine headache and a sinus infection is very important because they require very different antibiotics and treatments. A migraine headache usually responds well to a medication called a triptan, which comes in several forms (an injection, pill or nasal spray). In our experience, we’ve seen some miraculous treatment of headaches with these medications.

The key point here is that migraines and bacterial sinus infections require very different treatments, so it is important that you are being treated in the right way.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island