Sinus headaches

Overview

Sinus headaches are headaches that may feel like an infection in the sinuses (sinusitis). You may feel pressure around the eyes, cheeks and forehead. Perhaps your head throbs.

But, this pain might actually be caused by a migraine.

Symptoms

Signs and symptoms of sinus headaches may include:

Pain, pressure and fullness in the cheeks, brow or forehead
Worsening pain if you bend forward or lie down
Stuffy nose
Fatigue
Achy feeling in the upper teeth

Sinusitis or migraine?

Migraines and headaches from sinusitis are easy to confuse because the signs and symptoms of the two types of headaches may overlap.

Both migraine and sinusitis headache pain often get worse when you bend forward. Migraine can also be accompanied by various nasal signs and symptoms — including congestion, facial pressure and a clear, watery nasal discharge. These are due to involvement of the autonomic nervous system in a migraine attack. In fact, studies have shown that most people who see a health care provider for sinus headaches are found to have migraines instead.

Sinusitis, however, usually isn't associated with nausea or vomiting or aggravated by noise or bright light — all common features of migraines.

Sinusitis usually:

Occurs after a viral upper respiratory infection or cold
Includes thick, discolored nasal mucus
Is associated with a decreased sense of smell
Causes pain in one cheek or upper teeth

Headaches due to sinus disease often last days or longer, and migraines most commonly last hours to a day or two.

When to see a doctor

Consult your provider if:

Your headache symptoms occur more than 15 days a month or require frequent pain medicine available without a prescription
You have a severe headache, and pain medicine available without a prescription doesn't help
You miss school or work because of frequent headaches or the headaches interfere with your daily life

Causes

Sinus headaches are usually associated with migraines or other forms of headaches.

Sinus headaches are associated with pain and pressure in the face and sinuses and can cause nasal symptoms. Most of these headaches are not caused by sinus infections and generally should not be treated with antibiotics.

Risk factors

Sinus headaches can affect anyone but may be more likely if you have:

A previous history of migraines or headaches
A family history of migraines or headaches
Hormonal changes associated with headaches

Prevention

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of headaches. One or more of these suggestions may be helpful for you:

Avoid triggers. If certain foods or odors seem to have triggered your headaches in the past, avoid them. Your provider may recommend you reduce your caffeine and alcohol intake and avoid tobacco.

In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
Exercise regularly. Regular aerobic exercise reduces tension and can help prevent headaches. If your provider agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling.

Warm up slowly, however, because sudden, intense exercise can cause headaches.

Obesity is also thought to be a factor in headaches, and regular exercise can help you maintain a healthy weight or lose weight.
Reduce the effects of estrogen. If estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the medications you take that contain estrogen.

These medications include birth control pills and hormone replacement therapy. Talk with your provider about the appropriate alternatives or dosages for you.

Diagnosis

The cause of headaches can be difficult to determine. The provider will question you about your headaches and do a physical exam.

Your provider may perform imaging tests to help determine the cause of your headache, including:

CT scan. CT scans use a computer to create cross-sectional images of the brain and head (including the sinuses) by combining images from an X-ray unit that rotates around the body.
Magnetic resonance imaging (MRI). With MRI, a magnetic field and radio waves are used to create cross-sectional images of the structures within the brain.

Treatment

Most people who assume they have sinus headaches actually have migraines or tension-type headaches.

Migraines and chronic or recurrent headaches may be treated with prescription medication that is either taken every day to reduce or prevent headaches or taken at the onset of a headache to prevent it from getting worse.

To treat these types of headaches, your provider may recommend:

Pain relievers available without a prescription. Migraines and other types of headaches may be treated with medications available without a prescription, such as acetaminophen (Tylenol, others), naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others).
Triptans. Many people with migraine attacks use triptans to relieve pain. Triptans work by blocking pain pathways in the brain, but promote constriction of blood vessels and should be avoided if you have a history of heart disease or stroke.

Medications include sumatriptan (Imitrex, Tosymra, others), rizatriptan (Maxalt), almotriptan, naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). Triptans are available as tablets, nasal sprays and injections.

A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved to be more effective in relieving migraine symptoms than either medication on its own.
Ergots. Ergotamine and caffeine combination drugs (Migergot) are less effective than triptans. Ergots seem to be most effective in those whose pain lasts for more than 72 hours.

Ergotamine may cause worsened nausea and vomiting related to your migraines and other side effects, and it may also lead to medication overuse headaches.

Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It's available as a nasal spray and in injection form. This medication may cause fewer side effects than ergotamine and is less likely to lead to medication-overuse headaches.

Ergots, including dihydroergotamine, promote constriction of blood vessels and should be avoided if you have a history of heart disease or stroke.
Lasmiditan (Reyvow). This newer oral tablet is approved for the treatment of migraine with or without aura. It blocks pain pathways, similar to a triptan medication, but it does not appear to constrict blood vessels.
CGRP antagonists. Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral calcitonin gene-related peptide (CGRP) receptor antagonists approved for the treatment of acute migraine with or without aura in adults.
CGRP monoclonal antibodies. Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality) and eptinezumab-jjmr (Vyepti) are newer drugs approved by the Food and Drug Administration to treat migraines. They're given monthly or quarterly by injection.
Anti-nausea medications. Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications include chlorpromazine, metoclopramide (Reglan, Gimoti) and prochlorperazine (Compro, Procomp).
Glucocorticoids. A glucocorticoid such as dexamethasone (Hemady) may be used in conjunction with other medications to improve pain relief. Because of the risk of steroid toxicity, glucocorticoids shouldn't be used frequently.

Preparing for your appointment

You're likely to start by seeing your provider. You may be referred to a neurologist who specializes in headaches and migraines.

Here's some information to help you get ready for your appointment and to know what to expect from your provider.

What you can do

Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restricting your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including major stresses or recent life changes.
Make a list of all medications, vitamins and supplements you're taking.
Take a family member or friend along, if possible. Someone who accompanies you can help you remember what your provider tells you.
Write down questions to ask your provider.

Preparing questions will help you make the most of your time with your provider. For sinus headaches, some basic questions to ask include:

What is likely causing my symptoms or condition?
Are there other possible causes for my symptoms or condition?
What tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach you're suggesting?
I have these other health conditions. How can I best manage them together?
Are there any restrictions I need to follow?
Should I see a specialist?
Is there a generic alternative to the medicine you're prescribing?
Are there brochures or other printed materials I can take with me? What websites do you recommend?

Don't hesitate to ask any other questions you may have.

What to expect from your doctor

Your provider is likely to ask you questions, such as:

When did you first experience your headache, and what was it like?
Has your headache been continuous or occasional?
Has anyone in your immediate family had migraines?
What seems to improve your headaches?
What appears to worsen your headaches?