Why Do I Have Sinus Headaches?

Why Do I Have Sinus Headaches?

The Sinus Headache Myth

There is a growing body of research that suggests that recurrent, episodic headaches that are accompanied by allergy or sinus symptoms are actually migraine headaches. Symptoms of migraine that may mimic sinus disease include: 

  • Sinus pressure or pain
  • Nasal congestion
  • Runny nose
  • Itchy nose
  • Watery Eyes

How can this be?

The answer is in the biology of the neurologic system. Scientists agree through rigorous research that migraine is a trigeminovascular disorder. Activation of the trigeminovascular system causes vasodilation of the (meningeal) blood vessels lining the brain, inflammation, and neurochemical production.

What does the trigeminal nerve have to do with allergy or sinus symptoms?

Activation of the trigeminal nerve during migraine can cause pain and/or pressure in the face which includes the forehead, cheekbone, and jaw. (These three branches of the trigeminal nerve are known as the ophthalmic branch, the maxillary branch and the mandibular branch respectively.)

Activation of this trigeminal system results in parasympathetic nervous system involvement, causing nasal congestion and watery, itchy eyes. (Visit the American Migraine Foundation website for more information on sinus and migraine.)

has this been thoroughly studied?

The short answer is, “yes.” The idea that sinus headache is actually migraine has been borne out in multiple thorough, credible scientific studies. For example:

American Migraine Prevalence and Prevention Study

The largest study of migraine patients ever conducted—the American Migraine Prevalence and Prevention Study—showed that only about half of the patients that fit the IHS criteria* for migraine had actually been correctly diagnosed. Of those that were undiagnosed, 42% incorrectly believed they actually had “sinus” headache.

According to the American Migraine Foundation, at least 36,000,000 Americans have migraine. This would indicate that almost 8 million migraine sufferers believe they have sinus headache, and thus, are not getting appropriate treatment for migraine.

Additional Studies

A small pilot study was conducted in 2001, involving 47 patients that had self-diagnosed “sinus” headache. 98% of the study participants fit the IHS criteria* for migraine-type headache.

A much larger study, conducted in 2004 and involving 452 primary care clinics in North America, screened almost 3000 patients who had either self-diagnosed or physician-diagnosed sinus headache. 97% of the patients reported moderate to severe head pain, plus some autonomic symptoms (sinus pressure or pain, nasal congestion, rhinorrhea, watery eyes, and itchy nose). Of the 2991 patients in the study, 88% of the patients were found to have migraine or probable migraine headaches according to the IHS criteria* for diagnosing migraine.

In yet another study, conducted in 2002 by Barbanti, et al, researchers looked at the percentage of migraine patients with autonomic features including: eye watering, eye redness, eyelid drooping, eyelid swelling, nasal congestion and nasal running. 127 consecutive migraine patients were interviewed, revealing that 45% of these patients had at least one autonomic feature with their migraine headaches.

Other Factors

Weather is known to be a significant trigger for migraine headaches. Coupled with the autonomic features that can accompany migraine, it is easy to see why there is so much confusion about sinus and migraine. According to a paper published in the Journal of Neurology, Neurosurgery and Psychiatry on the comorbidities of chronic migraine in 2010, the two top comorbities are allergy (60%) and sinusitis (45%).

(Read Sinus Headache or Migraine (PDF) or “Allergy, Rhinitis and Migraine Headache” to learn more about the link between allergy, sinus and migraine.)


Patients who experience sinus pressure or pain, nasal congestion, itchy or runny nose, and watery eyes often believe they are suffering from "sinus" headache. But a growing amount of scientific research suggests that "sinus" headache is actually migraine. ​

Accurate diagnosis is a critical component of successful treatment and prevention. If you think your "sinus" headaches may actually be migraine, you will likely benefit from examination and diagnosis by a headache specialist.

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