Your sinus headache may not be what you think

Nearly everyone experiences a headache at some point, and the pain can range from mild to debilitating.

Sometimes, headaches are accompanied by pain and pressure in your brow and forehead, and cause nasal symptoms. Many people associate sinus and nasal symptoms with a sinus infection, also called sinusitis, or with an upper respiratory infection, a cold. They may say that they are experiencing a sinus headache. But sinus and nasal symptoms often can signal something else: a migraine headache.

The term "sinus headache" is not an actual medical diagnosis. Studies show that 90% of people with symptoms of a sinus headache are experiencing migraine headaches.

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. Also, migraine headaches affect people differently and symptoms can change over time. This is why many who have had migraine headaches in the past are surprised when they begin having sinus and nasal symptoms with a migraine headache.

Sinusitis, however, usually isn't associated with nausea or vomiting, nor is it aggravated by noise or bright light — all common features of migraines.

Sinusitis usually occurs after a viral upper respiratory infection or cold, and includes thick, discolored nasal mucus, decreased sense of smell, and 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.

Previous misdiagnosis

Many people who assume they have headaches from sinusitis have been misdiagnosed and prescribed an antibiotic for sinusitis. In these cases, the antibiotics are not necessary and could be harmful. Some people may feel better after they take the antibiotic because it may decrease inflammation in the sinuses caused by the migraine headache or because they think the antibiotic is helping, known as the placebo effect. Despite this, an antibiotic is not the correct treatment for a migraine headache.

These are a few ways you can tell whether your sinus and nasal symptoms are part of a sinus infection or part of a migraine headache:

Risk factors

Migraine headaches can affect anyone. However, they are more common in people between age 20 and 50. More than twice as many women as men have migraine headaches. Women over 50 often have fewer and less severe migraine headaches than they had earlier in life. Sometimes, migraine headaches stop after menopause.

Migraine headaches tend to run in families. Seventy-five percent of people with migraine headaches have a family history of migraine headaches.

Proper diagnosis

The cause of headaches can be difficult to determine. Your health care provider will ask you questions about your headaches and do a physical exam. You may have a CT scan or MRI to help determine the cause of your headache. There are several ways to treat headaches, and your care team will work with you to determine the best option for you.

Talk with your primary care provider if your headache symptoms happen more than 15 days a month, over-the-counter pain medication doesn't work, or you miss school or work because of frequent headaches.

Call 911 if you have the worst headache of your life or a sudden, severe headache accompanied by any or all of these:

• Confusion or trouble understanding speech
• Fainting
• High fever
• Numbness, weakness or paralysis
• Trouble seeing, speaking or walking

Quintin Cappelle, M.D., is an otorhinolaryngologist and head and neck surgeon in La Crosse and Onalaska, Wisconsin. Scott Spritzer, D.O., is a neurologist in Eau Claire, Wisconsin.