Sinus Headache vs Migraine: How to Tell the Difference (Most "Sinus" Headaches Are Migraines)

Written by Cherlie Joseph, MSN, FNP-BC · Medically reviewed by Naurah Gaspard, DNP, FNP-C, FNP-BC · Updated November 2026

A true sinus headache comes with a sinus infection: thick yellow or green mucus, a blocked nose, and often fever, lasting 10 days or more. A headache with face pressure that throbs, comes back in episodes, and brings nausea or light sensitivity is far more likely a migraine. In studies, most people who believed they had sinus headaches actually met the criteria for migraine.

Why sinus headaches get mixed up with migraines

Migraine attacks often cause pain across the forehead, around the eyes and over the cheeks, exactly where your sinuses sit. Migraines can also trigger a runny nose, watery eyes and nasal stuffiness, because the same nerve network that carries migraine pain also controls the nose and tear glands. So a migraine can look and feel like a sinus problem.

The research is striking. In the Sinus, Allergy and Migraine Study (SAMS), 88% of nearly 3,000 primary care patients with a history of "sinus headaches" actually had migraine or migraine-type headache. In a smaller study of 100 adults who answered an ad for self-diagnosed sinus headache, 86% had migraine or probable migraine, and only 3 kept a sinus diagnosis. Those few had clear infection signs like thick discolored discharge, fever or bad-smelling breath.

Getting the label right matters. Antibiotics and decongestants will not stop a migraine, and repeated rounds of antibiotics for headaches that are really migraines add side effects without relief.

Sinus headache vs migraine: side-by-side

Feature	Sinus infection headache	Migraine
Timing	Starts with or after a cold; steady for days	Episodes lasting 4 to 72 hours, then gone
Pain quality	Dull pressure or fullness	Throbbing or pulsing, often one side
Nasal mucus	Thick, yellow or green	Clear and watery, if any
Fever	Possible	No
Nausea, light or sound sensitivity	Uncommon	Common
Smell	Reduced sense of smell	Smells may feel stronger or bothersome
Pattern	A few times a year, with colds	Repeats; may follow weather, sleep, hormones, stress, alcohol

Weather changes, Florida's humid summers and allergy flares can trigger both migraine and sinus symptoms, which adds to the confusion. If your "sinus headaches" come several times a month, with no thick mucus or fever, migraine is the more likely answer.

A quick self-check: the POUND questions

Clinicians use five features, remembered as POUND, to screen for migraine:

• Pulsating or throbbing pain
• DOuration of 4 to 72 hours without treatment
• Unilateral, meaning one side of the head
• Nausea or vomiting
• Disabling intensity, so you have to stop what you are doing

If four or five of these fit your headaches, migraine is very likely. If two or fewer fit, migraine is less likely, and another cause (including a real sinus infection or tension-type headache) should be considered. This is a screening tool, not a diagnosis, but it is a helpful starting point for a conversation with your provider.

What helps a sinus headache

Most sinus infections are viral and improve on their own within 7 to 10 days. Pressure usually eases with:

• Saline rinses or sprays to thin mucus
• A steroid nasal spray such as fluticasone or triamcinolone
• Warm compresses and steam
• Acetaminophen or ibuprofen as directed on the label

Antibiotics are considered when symptoms last more than 10 days without improving, start severe with high fever and facial pain, or get worse after first getting better. A provider can sort out which pattern you have.

What helps a migraine

Migraine treatment works best taken early in an attack. Options include:

• Over-the-counter: ibuprofen, naproxen, aspirin, acetaminophen, or combination products with caffeine, used as the label directs.
• Prescription: triptans such as sumatriptan or rizatriptan, and anti-nausea medicine. Newer options (gepants such as ubrogepant and rimegepant) may be used for people who cannot take triptans.
• Prevention: if you have frequent attacks, daily preventive medicine and trigger tracking can cut how often migraines happen.

Using pain relievers on many days a month can cause medication overuse headache, which makes headaches more frequent. If you need pain medicine more than a couple of days a week, talk with a provider about prevention. OurTopClinic does not prescribe opioids or butalbital products for headaches.

Frequently asked questions

Can a migraine cause a stuffy or runny nose?

Yes. Migraines can trigger nasal congestion, a clear runny nose and watery eyes on the side of the pain. These symptoms come and go with the headache, unlike a sinus infection, which brings thick discolored mucus for days.

Do sinus headaches happen without a sinus infection?

Headache experts now consider a true sinus headache to be part of an active sinus infection. Repeated face-pressure headaches without infection signs are usually migraine or tension-type headache.

Will a decongestant help a migraine?

Usually not. Decongestants can ease stuffiness but do not stop a migraine attack, and they can raise blood pressure. Migraine-specific treatment works better.

Sources

• Eross E, et al. The Sinus, Allergy and Migraine Study (SAMS). Headache. PubMed
• Boisselle C, et al. What clinical clues differentiate migraine from sinus headaches? Journal of Family Practice
• Sinus headache or migraine? Considerations in making a differential diagnosis. PubMed

Keep reading

• Sinus infection vs cold: how to tell the difference
• Sinus pressure relief: 9 ways to ease facial pain
• Chronic sinusitis: when it won't go away
• Browse all conditions and treatments A to Z

This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.