Is It a Sinus Headache or a Migraine? An ENT in Gangnam, Seoul Explains
Answered by Dr. Kim Yoo Suk, MD · Board-certified otolaryngologist · Former professor, Yonsei & Ajou University · Consultations in English
SHORT ANSWER
Many headaches people call sinus headaches are actually migraines or tension headaches. A true sinus headache usually comes with other sinusitis signs, such as thick discolored discharge, nasal blockage, and reduced smell, often after a cold. Recurring facial pressure without these nasal symptoms, especially with nausea or light sensitivity, points more toward migraine.
Facial pressure is not always a sinus problem
A sinus headache is pain caused by inflammation and pressure in the sinuses, the air spaces in the cheeks, forehead, and between the eyes. Because migraines can also cause pain in these areas, along with a runny or stuffy nose, the two are frequently confused. Studies of people who believed they had sinus headaches have found that many actually met the criteria for migraine.
Features that suggest sinusitis
- Thick yellow or green discharge, or postnasal drip
- Nasal blockage and a reduced sense of smell
- Pain that began during or after a cold
- Pressure that worsens when bending forward and lasts for days
- Upper tooth pain on one side
- Fever in some acute cases
Features that suggest migraine
- Recurring attacks lasting hours to a few days, with symptom-free periods in between
- Throbbing pain, often on one side
- Nausea, sensitivity to light, sound, or smells
- Triggers such as sleep loss, stress, hormonal changes, alcohol, or weather
- Clear, watery nasal drip during attacks rather than thick discharge
- A family history of migraine
Tension headaches, jaw joint problems, and dental issues can also cause facial and forehead pain.
Why the difference matters
Treating a migraine with repeated antibiotics or decongestants will not help and may cause side effects, including rebound congestion. Conversely, true chronic sinusitis needs treatment of the inflamed sinuses, not just pain relievers.
What we do at Gangnam Yonsei ENT
The fastest way to tell them apart is to look inside. Dr. Kim Yoo Suk, a rhinology subspecialist and former Ajou University assistant professor who has published on symptom-based diagnosis of chronic rhinosinusitis, performs a nasal endoscopy to check for pus, polyps, or swelling at the sinus openings. If findings are unclear or symptoms are persistent, a sinus CT scan shows whether the sinuses are actually inflamed.
A normal endoscopy and CT during a headache episode strongly suggest the pain is not coming from the sinuses. In that case, you can be guided toward appropriate headache care. If sinus disease is confirmed, treatment includes saline irrigation, steroid sprays, antibiotics when bacterial infection is likely, and occasionally surgery. Sometimes contact points between a deviated septum and the turbinates are considered as a possible contributor, but this is assessed cautiously.
A headache diary helps
Before your appointment, note the date, duration, location, and intensity of each headache, along with any nasal symptoms, triggers, and the medicines you took. Two or three weeks of notes often reveal a clear pattern. Recording how often you use pain relievers is also important, as frequent use can itself lead to medication-overuse headache.
Warning signs that need urgent care
Seek emergency care for a sudden "worst-ever" headache, headache with fever and stiff neck, confusion, weakness, vision loss, or swelling around the eye. These are not typical of either simple sinusitis or migraine.
English consultations are available near Gangnam-gu Office Station; see location and hours. Related: sinus infection or cold and how long sinusitis lasts.
Related questions
Can weather changes cause sinus headaches?
Changes in air pressure and humidity can trigger migraines in sensitive people, and these are often mistaken for sinus headaches. Weather can also worsen nasal congestion. If headaches follow weather changes without discharge or blockage, migraine is a likely explanation.
Will a CT scan show if my headache is from my sinuses?
A CT scan shows whether the sinuses are inflamed or blocked. If the scan is clear, especially when taken during symptoms, the headache is unlikely to be from the sinuses. Results are interpreted alongside the endoscopy and symptom history.
Do decongestants help sinus headaches?
Short-term decongestants may ease pressure from acute sinus congestion. They do not treat migraines and should not be used for more than a few days, because nasal decongestant sprays can cause rebound congestion with prolonged use.
Your doctor
Dr. Kim Yoo Suk, MD
Board-certified otolaryngologist (ENT). Former clinical assistant professor at Yonsei University and assistant professor at Ajou University School of Medicine. Nose & sinus subspecialist who treats all ear, nose and throat conditions.
Consultations in English. Guide for international patients →
Visit us in Gangnam
2F HS Tower, 703 Seolleung-ro, Gangnam-gu, Seoul
Gangnam-gu Office Station (Line 7 / Suin-Bundang), Exit 3-1
Mon, Tue, Thu, Fri 9:00–19:00
Wed 14:00–19:00 · Sat 9:00–14:00
Closed Sundays & public holidays
This answer is general medical information written and reviewed by an ENT specialist. It is not a diagnosis. Please see a doctor for an examination. In an emergency in Korea, call 119.