Migraine or Sinus Disease?

One of the more common reasons patients come to see me is because they think they have a sinus infection. Often they say they have pain in the sinus below their eye, nasal congestion, and may have drainage. They  tell me that they’ve had it before, and antibiotics help.

Careful questioning often reveals that they are really have a migraine headache. Typically they start as a teenager or young adult, and tend to decrease in frequency and severity in the 40’s to 50’s. They may occur on one or both sides of the head, and are often associated with nausea, sensitivity to light and sound, and sometimes people get blurred vision or see white spots or zigzag lines. Going to sleep helps. Migraines are more frequent in females and tend to run in families. If patients are unaware of a family history of headaches, I tell them to ask their mother, sister or daughter because they may just not have mentioned it.

Patients think antibiotics help because their headaches get better a few days after they start the medicine. But migraines generally only last 4 hours to 3 days if you don’t take anything. So the antibiotics get the credit, when none is due.

Sometimes the pain from a migraine goes into the neck, or it’s only felt there, and patients think they have a neck problem. They may go to a chiropractor or massage therapist before they see me.

Migraines are also confused for sinusitis because nerves from the brain that are activated with migraines can stimulate the nose to cause congestion. ‘Sinus Headaches’ was invented by Madison Avenue (or at least some advertising agency) to sell pills. Outside the United States, you won’t find such pills being advertized or sold. Some people truly have headaches from sinus infections, but many headaches thought to be sinusitis, are really migraines.

There are lots of ways to treat migraines, which I won’t discuss in this article, but first you have to get the diagnosis right.

If you have headaches or neck pain, be careful about telling your doctor that you think you have a sinus infection or neck arthritis. You may just convince them you’re right, when maybe you’re having a migraine.

Author: Daniel Ginsberg, MD, FACP

I'm an internal medicine physician and have avidly applied computers to medicine since 1986, when I wrote my first medically oriented computer programs. So yes, that means I'm at least 35-years-old! View all posts by Daniel Ginsberg, MD, FACP