What Is a Sinus Migraine?

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Did you know that “sinus headache” isn’t really a thing? Well, it’s a term that’s widely used, but most people—including some general neurologists—misunderstand it. Sinus infections affect approximately 30 million Americans each year; however, for about 70-80% of people with sinus complaints, symptoms improve without the use of antibiotics in two weeks. 

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High school biology reminds us: infections need antibiotics to resolve. So why do these assumed sinus infections improve without them? The symptoms are very real: facial pain, heavy sinus pressure, runny nose, post-nasal drip, stuffy nose, teary or dry eyes. 

Studies show that close to 90% of self-reported “sinus headache” meets the diagnostic criteria for migraine. When treated with migraine-specific medications like triptans, these headaches typically respond well, strongly suggesting that what many experience as sinus pressure or pain is migraine.

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The idea of sinus migraine has been circulating in medical conversations since 2002, though it’s yet to be formally recognized in the International Classification of Headache Disorders, and the lack of established terminology and diagnostic criteria makes it confusing for both patients and physicians (To emphasize this, we’ve italicized the term throughout to reinforce that this isn’t an official or established term, and we recognize that sinus migraine is not a disease of the sinuses but is pain experienced in the sinus-region due to trigeminal nerve dysfunction, which we’ll get into). 

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Regardless of the label, the reality is that migraine attacks can mimic sinus infections in both sensation and location, leading to widespread misdiagnosis.

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Sinus Infection vs. Sinus Migraine: Why They Seem So Similar

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Both conditions cause similar symptoms:

• Facial pressure or pain, especially around the eyes, cheeks, or forehead (think sinus pressure)
  
  
• Stuffy or runny nose
  
  
• Post-nasal drip
  
  
• Headache worsened by bending over or lying down
  
  

First, let’s talk about facial pain and facial pressure. It’s easy to assume that pain and pressure limited to the face, cheeks, or sinus region must be a disease of the sinuses, but that’s not the case. During a migraine attack, the trigeminal nerve (which provides sensation to the face and sinus region) can become dysfunctional and send pain signals to the sinus region, even if there is no sinus infection or inflammation. That’s why this particular type of migraine pain can feel like it’s a sinus problem, even when your sinuses are beautifully healthy.

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Also, migraine can trigger autonomic symptoms like nasal congestion, runny nose, and eye watering, regardless of the migraine attack type. So, the combination of facial pressure and pain with autonomic symptoms mimics a sinus infection without any bacterial or viral cause. But it’s still missing two features: fever and disgusting, thick, discolored discharge.

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It feels like a sinus infection, even to those who have experienced many sinus infections before. But unless there’s purulent discharge involved, it’s more likely to be migraine. 

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But because migraine is often perceived as the singular stereotype (scorching bad headache with nausea and vomiting, and the absolute inability to be around any light), providers like general practitioners and ENTs rely on facial pain and pressure in their diagnosis and forgo confirmation of purulent discharge… because it can be difficult to identify unless there’s a nasal endoscopy or CT scan, and even those can be unreliable. So general practitioners, ENTs, and even some general neurologists may dismiss migraine if it’s not presenting with stereotypical symptoms like vomiting or severe head pain.

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As a result, many patients are misdiagnosed and treated for sinus infections when they’re actually experiencing migraine attacks. And if they’re on their third or fourth day of facial pain, they’re now in status migrainosus (a migraine complication). This misclassification can lead to patients receiving unnecessary antibiotics while their migraine remains untreated, further compounding their frustration and disability, and maybe even leading to disease progression.

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The Hidden Costs of Misdiagnosis: Why Treating Sinus Migraine Matters

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Last year, research highlighted the underuse of appropriate migraine treatments, showing that the underuse of both preventive and acute migraine medication has been shown to contribute to disease progression. 

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Think of migraine as being like a wildland fire: The longer the fire isn’t addressed, the bigger and nastier it gets. There are environmental factors and various other triggers (stress, hormones, weather, comorbidities, lack of sleep, etc) that contribute to the fire getting larger, nastier, hotter, and weirder. 

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The longer the fire remains, the more that area (your nervous system) begins to think this ever-growing fire is normal and what it should be doing (this a process called central sensitization), making it more difficult for all the wildland fire fighters to contain and suppress the fire because the terrain itself (again, your nervous system) has changed.

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That’s what happens with migraine progression and chronification: The longer someone waits to receive appropriate treatment, the higher their risk for disease progression. 

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So, imagine how misdiagnosis affects people living with sinus migraine. Their sinus migraine can be confused with and treated for sinus infections for years, leading to disease complications. 

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Confusing sinus migraine with an infection leads to:

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• Chronic, untreated migraine attacks
  
  
• Increased risk of progressing to chronic migraine (remember the wildland fire)
  
  
• Reduced quality of life and increased healthcare costs
  
  

It’s critical to understand that migraine doesn’t have to be super severe or wildly painful to be migraine. Even mild head pain, when accompanied by other migraine symptoms, still qualifies as a migraine attack and deserves treatment.

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Evidence-Based Treatments for Sinus Migraine

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The good news? Patients who believe they have “sinus headaches” often respond beautifully to migraine-specific treatments like triptans. Studies have shown that triptans (which target migraine-specific pathways) are effective in these cases because they work by blocking pain signals in the trigeminovascular system, mechanisms irrelevant to sinus infection but central to migraine pathophysiology (which is why triptans do nothing for actual sinus infections).

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Sinus Migraine Acute Treatments

• Triptans (Sumatriptan, Rizatriptan, etc.) – block trigeminovascular pain; very effective if taken at the very onset of attack
  
  
• NSAIDs (naproxen, diclofenac, or toradol) – reduce inflammation, which can treat pain
  
  
• Combining Triptans with NSAIDS – the power combination
  
  
• Anti-nausea medications (reglan, compazine, promethazine, etc)
  
  
• Supportive treatments like Flonase and intranasal saline spray may reduce mucosal inflammation if there’s nasal congestion and a runny nose
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Sinus Migraine Preventive Treatments

• CGRP inhibitors
  
  
• Blood pressure or cardiac medications
  
  
• Antidepressants
  
  
• Anti-seizure medications
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Decongestants, like pseudoephedrine, are discouraged as they may cause complications. As an acute treatment, gepants can be helpful, but they don’t have the vasoconstrictive effect that triptans have.
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Why Specialized Headache Clinics Are Best for Sinus Migraine

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Due to the subtlety of sinus migraine symptoms and their overlap with ENT-related conditions, specialized headache clinics like Neura Health are the best place for accurate diagnosis and effective treatment. Even many general neurologists may miss the nuanced presentation of sinus migraine.

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At Neura Health, patients receive care from providers trained specifically in headache medicine, ensuring the most precise and personalized treatment.

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Neura Health’s Patient-First Approach to Treating Sinus Migraine

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Neura Health offers a patient-first, virtual care model, providing:

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• Access to headache specialists (MDs & DOs, typically trained neurologists, with an additional fellowship in migraine and headache disorders), as well as specialized NPs & PAs who are trained specifically to treat headache disorders including sinus migraine.
  
  
• Personalized care plans based on migraine type, severity, and other health factors, such as co-occurring conditions.
  
  
• Twice-weekly care coaching to support lifestyle changes, medication adherence, and goal-setting.
  
  
• The Neura Health app, which includes:
  
  
  
  • Headache and symptom tracker
    
    
  • Educational library
    
    
  • Chat feature with the care and concierge team
    
    

This integrated approach ensures patients no longer feel like they’re navigating migraine alone, and that their sinus migraine attacks are finally recognized and treated correctly. Because that’s what migraine patients deserve.

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Stop Living with “Sinus Headaches”—Find the Right Care Today

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If you’re experiencing weekly headaches or what you believe are “sinus headaches,” this is not normal, and if you’re having frequent headache days or “sinus headache days,” it’s time to see a headache provider who not only understands the difference but knows how to appropriately treat the disease.

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Neura Health is ready to help you find relief, understand your migraine type, and finally feel heard and supported. If you’re interested in learning more about Neura Health’s approach to patient care, schedule a 15-minute call with one of our membership advisors. They’ll be happy to explain what our approach to patient care is, as well as answer questions about care coaching, insurance, our providers, and most other non-medical related questions you may have.

Frequently Asked Questions (FAQs)

Q1: Is sinus migraine officially recognized by doctors?

A1: While not yet included in the International Classification of Headache Disorders, sinus migraine is widely understood in headache medicine and recognized by headache specialists and NPs and PAs specialized in headache disorders. If anything, it needs a consistent name to reduce confusion and help patients receive the appropriate diagnosis.

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Q2: Can sinus migraine occur without head pain?

A2: Yes. Migraine can present with facial pain, pressure, or autonomic symptoms without stereotypical, severe head pain.

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Q3: Will antibiotics help a sinus migraine?

A3: No. Sinus migraine is not caused by an infection, so antibiotics typically won’t provide the same relief as targeted migraine acute therapies.

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Q4: Why do triptans work for sinus migraine but not sinus infections?

A4: Triptans target migraine-specific pathways in the brain, which aren’t involved in sinus infection pain.

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Q5: Can general neurologists treat sinus migraine?

A5: Some can, but many lack specialized training in headache medicine. Headache clinics or providers with headache training or certification are best because they understand the nuance and the importance of tracking both headache days and symptomatic days that people may not associate with migraine.

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Q6: How can Neura Health help me with sinus migraine?

A6: Neura Health offers specialized, telehealth care with trained headache providers, personalized treatment plans, and ongoing support via the app and coaching. Provider appointments are typically scheduled in just a few days. All headache and migraine patient appointments are conducted via Zoom, with a headache specialist or a specialized nurse practitioner, or a physician assistant. 

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Neura Health patients receive a thorough new patient appointment, conducted with a comprehensive patient history and virtual neurological exam. Any labwork or imagery would be local, but coordinated by your Neura Health concierge team. Follow-up appointments typically take place every three months, but may follow a different schedule based on patient need.

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Does this sound like the kind of care you need?
Sign up for Neura Health today and discover what it’s like to receive comprehensive, patient-first care.

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