Is it a Sinus Headache or a Migraine?

TOMBALL, Texas – February 13, 2017 — If you have ever missed work because of a severe headache you are certainly not alone. Migraine headaches are the third most common illness in the world, with an estimated 37 million Americans suffering migraines at least occasionally, costing the country billions of dollars in medical care and lost productivity each year. Additionally, 1 in 10 school-aged children suffer from migraine headaches.

One of the more challenging aspects of treating headache conditions is distinguishing between the various types – most notably, the difference between a migraine and a sinus headache. Recent research revealed that headaches have been frequently misdiagnosed and mistreated.

Micah Bosley, MD, and Richard Milian, MD, are family medicine specialists who practice with Affinity Medical Associates.  They encourage those experiencing severe headaches to schedule an appointment with their physician to correctly diagnose the symptoms and determine the appropriate solution and path to relief.

“We find that self-diagnosed sinus headaches are nearly always migraines,” said Dr. Bosley.  "A sinus headache is actually a migraine accompanied by sinus symptoms, which makes self-diagnosis difficult and inadvisable if you are a regular or chronic sufferer.  The confusion is not surprising, as the symptoms and causes have many similarities, and in both cases the pain occurs near and around the sinus cavity.”

Sinus headache – or sinusitis – is associated with a pus-like nasal discharge that represents a potential infection in the sinuses. Migraine may be associated with watery eyes and runny nose, but the fluid is clear and not the cause of the pain. Sinus headaches are not normally disabling, while migraine pain can be severe to disabling.  The key distinguishing features of migraine are:

  • Nausea or vomiting
  • Sensitivity to light or noise
  • Moderate to severe pain in head and/or neck, usually located only on one side of the head
  • Pulsing/throbbing pain
  • Headache is worsened by activity or movement

Experts advise that you go beyond the location of the pain and pressure, and look for a headache associated with the inability to function normally at school or work, nausea and light sensitivity, and triggers such as weather change, menstrual cycle and physical or emotional stress. Most notably, it is commonly assumed that a headache associated with weather change is a sinus headache, when weather changes are actually a common trigger for migraines. Additionally, migraine may be hereditary.  If other family members are migraine sufferers, it’s more likely that your headaches are migraine, as well.  Ask yourself these questions, known as the ID Migraine Questionnaire developed by Dr. Richard Lipton:

  • In the past 90 days, have you experienced headaches that interfere with your ability to function normally?
  • Are your headaches ever accompanied by nausea?
  • When you have a headache, does bright light make the pain worse?

If you answered ‘yes’ to two of these three questions, migraine is the likely diagnosis 93% of the time. If all three are true, there is a 98% chance the diagnosis is migraine.

Most patients included in the recent research studies who complained of ‘sinus headache’ were taking a large amount of over the counter and prescription decongestants, antihistamines, nasal sprays, analgesics and NSAIDS, but expressed significant dissatisfaction with the results.

“An effective method for diagnosing your headaches with certainty is to ask your doctor for a migraine-specific medication,” said Dr. Milian.  "Try the migraine medicine for your next three ‘sinus headaches’ and evaluate the impact on symptom relief, compared to the sinus medicines you’ve used in the past.  In some cases, a more extensive evaluation may be recommended, such as a CT scan of your sinuses to rule out sinus disease, or an MRI to rule out any issues associated with the brain. These diagnostics can help reassure you that your condition is truly a migraine, and that you are treating it appropriately.”

Affinity Medical Associates is a network of providers who serve the Northwest Houston area at nine convenient locations.  They offer a wide range of care, including family medicine, pediatrics, internal medicine, endocrinology, obstetrics and gynecology. 


Dr. Bosley and Dr. Milian are currently accepting new patients at the Michel Rd. Clinic located at 12635 Michel Rd., Tomball 77375.  To schedule an appointment, call 832-843-5086 or visit




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