Chapter 1, Episode 11: What is Sinus Migraine?


This content has been medically reviewed by Dr. Frederick Godley. This is not a recognized headache type by the International Classification of Headache Disorders 3rd edition and is a hypothesis by Dr. Godley and other otolaryngologists.

Have you taken numerous antibiotics or had surgery for a “sinus infection” that won’t go away?

If so, it’s possible that your symptoms are being caused by a phenomenon known as sinus migraine or mid-facial migraine. This condition isn’t yet widely recognized, and it is often misdiagnosed as sinusitis. 

Sinusitis is an infection that causes inflammation of the tissue in the sinuses, which are cavities within the bones around your eyes and nose. Symptoms include runny or stuffy nose, facial pain or pressure, headache, discolored mucus, post-nasal drip and sore throat. Chronic sinusitis is when these symptoms occur for three months or longer. 

Most often, sinusitis is treated with antibiotics, steroids or in some cases surgery. If the condition does not improve with typical treatments, it’s possible the correct diagnosis could be something else, like sinus migraine.

Sinus migraine occurs due to hyperactivation of the trigeminal and autonomic nervous systems.  It is believed that the first branch of the trigeminal nerve is responsible for the head pain that occurs with migraine but the second branch connects to sensors in the sinuses which can cause pressure, as well as pain, across the forehead, behind the eyes or nose, and beneath the cheeks mimicking some of the symptoms of sinusitis. 

People with sinus migraine may also experience nasal congestion, tearing of the eyes, runny nose, ear pain or pressure and/or dizziness, sometimes along with more typical migraine symptoms like head pain, nausea, and light, sound and smell sensitivity. 

Sinus migraine is most common in middle aged women and typically worsen with the onset of menopause.

What are the differences between sinusitis and sinus migraine?

  1. Sinus migraine can produce a lot of secretions from the nose but, in contrast, secretions from sinusitis are typically thick, discolored and almost always taste awful.
  2. While headache can be present with both sinusitis and sinus migraine, sinusitis does not include nausea, vomiting, and light, sound and smell sensitivity which could be indicators of migraine. 
  3. Having a family history of migraine disease may help to distinguish these two conditions.
  4. Symptoms of migraine disease tend to change over a lifetime, therefore a prior history of classic migraine may be an indicator that sinus migraine is a new form of the same disease. 

Can antibiotics, steroids or sinus surgery help sinus migraine?

Antibiotics and steroids are frequently prescribed as a first-line treatment for sinusitis. Feeling temporarily better after taking antibiotics or steroids may not be a reliable way to distinguish a sinus infection from sinus migraine because these medications may reduce inflammation, calm nerves and provide short-term relief…even if you have sinus migraine.

And when antibiotics fail, some people undergo sinus surgery. Since surgery can disrupt the nerves, it, too, can temporarily relieve the pain and pressure associated with sinus migraine. However, many people do not get any relief from these options. Generally, sinusitis treatments are not the best strategies for treating sinus migraine. 

So how can you treat sinus migraine?

Both traditional abortive and preventive migraine treatments may also relieve sinus migraine symptoms. Triptans, which are migraine abortive treatments, have proved to be effective for sinus migraine. In fact, triptans may be used to diagnose the condition because if someone experiences symptom relief then the cause was most likely sinus migraine not sinusitis.

If you are experiencing sinus symptoms and believe it may be sinus migraine, tell your provider about this under-diagnosed condition. Collaborative care by a neurologist and an ear, nose and throat doctor is recommended to rule out other causes and to receive proper treatment for sinus migraine.

This video is sponsored in part by Amgen and Collegium Pharmaceutical.

*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.