Sinus Headache Guide: Symptoms, Causes, Diagnosis, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
TL;DR
Sinus headaches are headaches that may feel like an infection in the sinuses (sinusitis), with pressure around the eyes, cheeks, and forehead that may throb — but this pain might actually be caused by a migraine [1]. In fact, studies show that most people who see a healthcare provider for sinus headaches are found to have migraines instead, because the two conditions share overlapping signs: both often worsen when bending forward, and migraine attacks can even bring congestion, facial pressure, and a clear, watery nasal discharge [1]. True sinusitis usually differs in key ways: it follows a cold or viral infection, includes thick discolored mucus and a reduced sense of smell, and lasts days or longer, whereas migraines most often last hours to a day or two and may bring nausea, vomiting, and sensitivity to noise or bright light [1]. The practical takeaway is important: most of these headaches are not caused by sinus infections and generally should not be treated with antibiotics; the right treatment depends on getting the diagnosis right, which may involve a physical exam, and sometimes a CT scan or MRI [1] [2].
Quick Answer
What it is: A headache that feels like a sinus infection (sinusitis), with pressure around the eyes, cheeks, and forehead [1].
The big surprise: Most people who see a provider for "sinus headaches" actually have migraines, and most of these headaches should not be treated with antibiotics [1].
The 5 signs: Pain/pressure/fullness in cheeks, brow, or forehead; worse when bending forward or lying down; stuffy nose; fatigue; achy upper teeth [1].
How to tell them apart: True sinusitis usually follows a cold, has thick discolored mucus, reduces your sense of smell, and lasts days or longer — migraines often bring nausea and sensitivity to noise or light, and last hours to 1–2 days [1].
When to see a doctor: Headaches 15+ days a month, severe pain that over-the-counter medicine doesn't help, or missed work/school [1].
What This Guide Is Based On
This guide is built entirely from specialist-reviewed clinical guidance, supported by peer-reviewed research in the American Journal of Rhinology & Allergy (Jayawardena et al., 2018) and Current Opinion in Neurology (Kaniecki, 2021), the Centers for Disease Control and Prevention's antibiotic-use guidance on sinus infections, the Merck Manual's sinusitis review, UpToDate's clinical reviews of headache evaluation and migraine treatment (Wootton et al.; Schwedt et al.), and the American Academy of Otolaryngology's patient education on sinus headaches. These peer-reviewed and institution-backed references are cited inline throughout, with the full list at the end of this guide [1] [2].
What Are Sinus Headaches?
Sinus headaches are headaches that may feel like an infection in the sinuses, a condition known as sinusitis. You may feel pressure around the eyes, cheeks, and forehead, and perhaps your head throbs [1].
But there is a twist worth knowing: this pain might actually be caused by a migraine. Sinus headaches are usually associated with migraines or other forms of headaches, and the pain and pressure in the face and sinuses can cause nasal symptoms on their own [1].
What Are the Symptoms?
If you have a sinus headache, you may notice pressure around the eyes, cheeks, and forehead, along with a handful of other signs. Studies have shown that most people who see a healthcare provider for sinus headaches are found to have migraines instead — which is why the full list of signs matters [1].
Symptom | What it feels like |
Pain, pressure, and fullness | Felt in the cheeks, brow, or forehead [1] |
Positional worsening | Pain worsens if you bend forward or lie down [1] |
Stuffy nose | Nasal congestion [1] |
Fatigue | A tired, drained feeling [1] |
Achy upper teeth | Discomfort in the upper teeth [1] |
The positional detail is distinctive: both migraine and sinusitis headache pain often get worse when you bend forward, so this sign alone cannot tell the two apart [1].
How Do You Tell a Sinus Headache from a Migraine?
Migraines and headaches from sinusitis are easy to confuse because their signs and symptoms may overlap [1]. Understanding the differences can save you from the wrong treatment.
Feature | Migraine | True sinusitis |
Nasal symptoms | Can include congestion, facial pressure, and clear, watery discharge (from autonomic nervous system involvement) [1] | Stuffy nose with thick, discolored mucus [1] |
Nausea and vomiting | Common [1] | Not usually associated [1] |
Sensitivity to noise or bright light | Common [1] | Not usually associated [1] |
What comes before it | Varies | Usually follows a viral upper respiratory infection or cold [1] |
Sense of smell | Unchanged | Decreased [1] |
Pain location | Varies | Often one cheek or the upper teeth [1] |
How long it lasts | Most commonly hours to a day or two [1] | Often days or longer [1] |
This matters because migraine can also be accompanied by various nasal signs and symptoms — including congestion, facial pressure, and a clear, watery nasal discharge — due to involvement of the autonomic nervous system in a migraine attack [1].
When Should You See a Doctor?
Consult your healthcare provider if your headache symptoms occur more than 15 days a month or require frequent pain medicine available without a prescription, if you have a severe headache that over-the-counter pain medicine doesn't help, or if you miss school or work because of frequent headaches [1].
What Causes Sinus Headaches?
Sinus headaches are usually associated with migraines or other forms of headaches, and they are associated with pain and pressure in the face and sinuses that can cause nasal symptoms [1].
Most of these headaches are not caused by sinus infections — and generally should not be treated with antibiotics [1]. This is the single most important point in the whole guide: reaching for an antibiotic for a "sinus headache" usually treats the wrong problem.
Who Is Most at Risk?
Sinus headaches can affect anyone, but they may be more likely under certain conditions. The source material lists three risk factors [1].
Risk factor | What it means |
A previous history of migraines or headaches | Past headache experience raises the odds [1] |
A family history of migraines or headaches | Headaches can run in families [1] |
Hormonal changes associated with headaches | Hormone shifts can trigger or worsen headaches [1] |
How Are Sinus Headaches Diagnosed?
The cause of headaches can be difficult to determine, so the provider will question you about your headaches and do a physical exam [2].
Sometimes imaging tests help determine the cause, and the source material names two options [2]:
Imaging test | How it works |
CT scan | A computer creates cross-sectional images of the brain and head — including the sinuses — by combining images from an X-ray unit that rotates around the body [2] |
MRI | A magnetic field and radio waves create cross-sectional images of the structures within the brain [2] |
How Are Sinus Headaches Treated?
Here is the crux of treatment: most people who assume they have sinus headaches actually have migraines or tension-type headaches [2]. So treatment generally targets migraines and chronic or recurrent headaches, which may be managed with prescription medication taken every day to reduce or prevent headaches, or taken at the onset of a headache to stop it from getting worse [2].
Your provider may recommend one or more of the following options [2]:
Treatment category | How it works |
Over-the-counter pain relievers | Acetaminophen (Tylenol), naproxen sodium (Aleve), and ibuprofen (Advil, Motrin IB) [2] |
Triptans | Block pain pathways in the brain; available as tablets, nasal sprays, and injections (sumatriptan, rizatriptan, and others); avoid with a history of heart disease or stroke [2] |
Ergots | Ergotamine-caffeine combinations are less effective than triptans but may help when pain lasts over 72 hours; dihydroergotamine (D.H.E. 45, Migranal) has fewer side effects; avoid with a history of heart disease or stroke [2] |
Lasmiditan (Reyvow) | A newer oral tablet for migraine with or without aura; blocks pain pathways without constricting blood vessels [2] |
CGRP antagonists | Oral tablets (ubrogepant, rimegepant) approved for acute migraine in adults [2] |
CGRP monoclonal antibodies | Monthly or quarterly injections (erenumab, fremanezumab, galcanezumab, eptinezumab) approved for migraines [2] |
Anti-nausea medications | Chlorpromazine, metoclopramide, and prochlorperazine, usually combined with other medications [2] |
Glucocorticoids | Dexamethasone may improve pain relief when combined with other medications; not used frequently because of steroid toxicity risk [2] |
A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved more effective at relieving migraine symptoms than either medication alone [2].
How Can You Prevent Sinus Headaches?
Whether or not you take preventive medications, lifestyle changes can help reduce the number and severity of headaches. The source material outlines three strategies [1].
Avoid triggers. If certain foods or odors have triggered your headaches in the past, avoid them. Your provider may recommend reducing caffeine and alcohol intake and avoiding tobacco. In general, establish a daily routine with regular sleep patterns and regular meals, and try to control stress [1].
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, 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 [1].
Reduce the effects of estrogen. If estrogen seems to trigger or worsen your headaches, you may want to avoid or reduce medications containing estrogen, such as birth control pills and hormone replacement therapy. Talk with your provider about appropriate alternatives or dosages [1].
How Should You Prepare for Your Appointment?
You're likely to start by seeing your primary provider, and you may be referred to a neurologist who specializes in headaches and migraines [2].
Before the visit, be aware of any pre-appointment restrictions (such as diet limits), write down your symptoms — including any that seem unrelated — and note key personal information like major stresses or recent life changes. Make a list of all medications, vitamins, and supplements you take, take a family member or friend along to help remember what your provider says, and write down your questions [2].
Be ready to answer questions about when your headache first started and what it was like, whether it has been continuous or occasional, whether anyone in your immediate family has had migraines, and what seems to improve or worsen your headaches [2]. The full guide includes eleven suggested questions for your provider, from "What is likely causing my symptoms?" to "Is there a generic alternative to the medicine you're prescribing?" [2].
Conclusion: Get the Diagnosis Right First
Sinus headaches feel like a sinus infection — pressure around the eyes, cheeks, and forehead that throbs and worsens when you bend forward — but the evidence says the more likely culprit is a migraine, and most of these headaches should not be treated with antibiotics. The five signs to watch are pain, pressure, and fullness in the cheeks, brow, or forehead; worsening when bending forward or lying down; a stuffy nose; fatigue; and achy upper teeth. The telltale way to separate true sinusitis from migraine is the pattern: sinusitis usually follows a cold, produces thick discolored mucus, dulls your sense of smell, and lasts days or longer, while migraines often bring nausea, vomiting, and sensitivity to noise or light, and run hours to a day or two. Diagnosis starts with questions and a physical exam, with CT scans and MRIs available when needed, and treatment spans eight categories — from over-the-counter pain relievers through triptans, lasmiditan, CGRP blockers, anti-nausea medicine, and glucocorticoids — matched to the true underlying headache type. Prevention rests on three habits: avoiding your triggers with a regular routine, exercising aerobically with a slow warm-up, and discussing estrogen-containing medicines with your provider.
If your headaches hit more than 15 days a month, over-the-counter medicine isn't enough, or you're missing work or school, contact your healthcare provider.
This guide is for general education only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions about a medical condition.
Frequently Asked Questions
What are sinus headaches?
Sinus headaches are headaches that may feel like an infection in the sinuses (sinusitis), with pressure around the eyes, cheeks, and forehead and possibly a throbbing sensation [1].
Are most "sinus headaches" really migraines?
Yes — studies have shown that most people who see a healthcare provider for sinus headaches are found to have migraines instead, because the signs and symptoms of the two overlap [1].
What are the signs of a sinus headache?
Pain, pressure, and fullness in the cheeks, brow, or forehead; pain that worsens when bending forward or lying down; a stuffy nose; fatigue; and an achy feeling in the upper teeth [1].
Should I take antibiotics for a sinus headache?
Usually not. Most of these headaches are not caused by sinus infections and generally should not be treated with antibiotics [1].
How do I tell a sinus headache from a migraine?
True sinusitis usually occurs after a cold or viral infection, includes thick discolored mucus and a reduced sense of smell, and lasts days or longer. Migraines more often last hours to a day or two and may include nausea, vomiting, and sensitivity to noise or bright light — features not usually associated with sinusitis [1].
How are sinus headaches diagnosed?
The cause of headaches can be difficult to determine, so your provider will question you about your headaches and perform a physical exam; imaging tests such as a CT scan or MRI may help determine the cause [2].
How are sinus headaches treated?
Because most people who assume they have sinus headaches actually have migraines or tension-type headaches, treatment usually targets migraines: over-the-counter pain relievers, triptans, ergots, lasmiditan, CGRP antagonists or monoclonal antibodies, anti-nausea medications, or glucocorticoids — prescribed for daily prevention or at the onset of a headache [2].
When should I see a doctor?
See a doctor if your headache symptoms occur more than 15 days a month or require frequent over-the-counter pain medicine, if a severe headache doesn't respond to over-the-counter pain medicine, or if headaches make you miss school or work or interfere with daily life [1].
References
Additional references consulted:
Jayawardena ADL, et al. Headaches and facial pain in rhinology. American Journal of Rhinology & Allergy. 2018; doi:10.2500/ajra.2018.32.4501.
Kaniecki R. Sinus, disabling tension-type, and temporomandibular joint headaches. Current Opinion in Neurology. 2021; doi:10.1097/WCO.0000000000000918.
Centers for Disease Control and Prevention: Sinus infection (sinusitis) — antibiotic use
Merck Manual Professional Version: Sinusitis
UpToDate: Evaluation of headache in adults (Wootton RJ, et al.); Acute treatment of migraine in adults (Schwedt TJ, et al.); Preventive treatment of episodic migraine in adults (Schwedt TJ, et al.)
American Academy of Otolaryngology — Head and Neck Surgery: Sinus headaches
National Institute of Neurological Disorders and Stroke: Headache information page
Source references:
Sinus headaches — Symptoms & causes (May 17, 2022)
Sinus headaches — Diagnosis & treatment (May 17, 2022)
Comments