Typically, a sinus headache is accompanied by other sinus-related symptoms. A severe headache without sinus symptoms could actually be a migraine.

If you have frequent headaches and pressure in your forehead, you may initially assume you have recurring sinus headaches, or sinusitis. These types of headaches may be induced by allergies or colds, and often cause congestion, runny nose, and a sore throat.

However, if you continue to have extremely painful headaches without the hallmark symptoms of sinusitis, you may be dealing with another health condition entirely.

In fact, the most common misdiagnosis of migraine is sinusitis. It’s also possible to have both migraine and sinusitis at the same time.

While it’s certainly possible to have a sinus headache without congestion, it’s important to be aware of other symptoms to make sure you’re treating the correct health issue.

Here’s what you need to know about both sinusitis and migraines, and when to see a doctor for treatment.

While it may feel similar, sinus headaches and migraines are very different. Let’s look at each.

Sinus headache

A sinus headache is characterized by pain and tenderness that occurs where your sinuses are located. This includes your:

  • forehead
  • nose, including the sides
  • cheeks
  • eyes


Sinus headaches occur when your sinuses become inflamed. Allergies and colds may cause these headaches, as well as blockages in the sinus cavities, such as nasal polyps. Sinus headaches are often accompanied by nasal congestion and colorful discharge, as well as a sore throat from post-nasal drip.

Chronic sinus headaches may also be called sinusitis. This condition can sometimes lead to recurring sinus infections. Sinusitis may also cause jaw and tooth pain. Another hallmark of chronic sinusitis is a decreased sense of smell, which does not happen with migraines.


A migraine is a health condition with a much different underlying cause. While sinus headaches are caused by inflammation in the sinuses, migraines are neurological-based. There are subtypes of migraines that lead to varying levels of pain—these are usually more severe than sinus pain.


Unlike sinus headaches though, migraines can cause an aura. This is known as a “complicated migraine.” It’s estimated that 25 percent of people with migraines experience an aura, which leads to symptoms such as blurry vision, body numbness, and speech difficulties.

Migraines are also notorious for causing light sensitivity, dizziness, and nausea. While sinusitis is extremely common, migraines affect an estimated 11 percent of adults worldwide.

The timing of your headaches is also an important consideration. While migraines may occur any time of the day, sinus headaches tend to be worse in the morning upon waking up.


If you experience ongoing headaches without sinus pressure, severe congestion, or other related symptoms, you may have a migraine instead.

This is a common misdiagnosis, with one 2013 study finding that 81.5 percent of 130 migraine patients were previously misdiagnosed with sinusitis.

Migraines may be initially misdiagnosed as sinusitis because both may cause forehead and eye pain. They can also affect one side of your head only. Furthermore, research has found that many people with migraines have also complained of a runny nose and nasal congestion.

Both sinus headaches and migraines can cause pressure on the front of the forehead. If your headache is truly related to your sinuses, you may have tenderness and pain in your cheeks and nose, as well as cold-like symptoms.

Aura, nausea, and dizziness, on the other hand, are common migraine symptoms. If you’re having a migraine, you may also notice that your symptoms worsen if you’re exposed to a lot of noise or bright light.

Below is a breakdown of common sinus headache and migraine symptoms for comparison:

Sinus HeadacheMigraine
Pain in foreheadXX
Pain on one side of headXX
Eye painXX
Pain in cheeks and noseX
Ear painX
Jaw and tooth painX
Bad breathX
Runny noseXX
Colorful nasal dischargeX
Nausea and/or vomitingX
Sore throatX
Gets worse with exposure to light or noiseX
Chronic headachesXX
Decreased sense of smellX

Depending on their underlying cause, sinus headaches may be treated with one or more of the following:

  • antihistamines, to reduce hay fever and other types of allergies that might irritate the sinuses
  • decongestants, to alleviate nasal congestion that may be causing pressure and pain in the sinuses
  • corticosteroids, to reduce inflammation
  • over-the-counter (OTC) pain relievers, to help mitigate your head and facial pain
  • antibiotics, if you develop a sinus infection
  • surgery, for severe cases that don’t respond to medications
  • allergy shots, for severe allergies

Migraines, on the other hand, aren’t alleviated by medications that treat allergies and cold symptoms. OTC pain medications may help an acute attack, but frequent usage has been found to make migraines worse.

Other possible migraine treatment options include:

  • botox injections, which may help relax the nerves that contribute to your migraine attacks
  • beta blockers or calcium channel blockers, which are types of blood pressure medications shown to prevent migraines
  • some anti-seizure and antidepressants, which can also be used to prevent migraines
  • calcitonin gene-related peptide (CGRP) monoclonal antibodies, which are also used to prevent migraines and require a monthly injection
  • triptans, a class of painkillers used specifically for migraines and cluster headaches
  • anti-nausea medications, to prevent you from getting sick
  • alternative medicine techniques, such as acupuncture, massage, or yoga
  • lifestyle changes, such as limiting or avoiding common triggers like red wine, artificial sweeteners, and soft cheeses

Recurring headaches and suspected acute sinusitis should always be evaluated by a doctor. Experts believe that most people who self-diagnose sinusitis are actually experiencing migraines. Getting the correct diagnosis is crucial to successful treatment.

Sinus pain and pressure that doesn’t improve after 7 days despite treatment could mean that you’re being treated for the wrong condition, especially if you don’t experience other sinus symptoms.

You should also see your doctor if your headaches are accompanied by symptoms typically experienced with migraine attacks.

You don’t have to be experiencing sharp head pain in order to have a migraine. Accompanying nausea, vision changes, and light sensitivity could mean you have a migraine, and not a sinus headache.

For migraine treatment, you can start with your primary care physician, and if needed you may be referred to a headache specialist, possibly a neurologist or ear, nose, and throat (ENT) doctor.

It’s possible to have a sinus headache without any congestion, especially if you have a history of allergies and other sinus issues. However, a sinus headache is usually associated with allergies, colds, or an infection.

Migraines are commonly misdiagnosed as sinusitis. This is partly due to the fact that these two health conditions can both cause pain in the forehead and eye areas. However, migraines can cause separate symptoms such as light and noise sensitivities, nausea, and blurry vision.

If you continue to experience head pain after being diagnosed and treated for sinusitis, see your doctor for further evaluation.