What Does a Sinus Headache Feel Like?

Sinus headache refers to symptoms of certain headaches that feature pain and pressure in the face, over the cheeks or forehead, or between or behind the eyes (where the sinuses are located).

Sinus headache refers to symptoms of certain headaches that feature pain and pressure in the face, over the cheeks or forehead, or between or behind the eyes (where the sinuses are located). 

Sinus headache is not a medical diagnosis but a description of symptoms of headaches, and studies have found that more than 80% of people who have self-diagnosed or been diagnosed with sinus headaches actually had migraines or tension headaches. Only 3% to 5% had inflammation of the sinuses (sinusitis). 

Sinus headache symptoms, including those cause by both migraines and sinusitis can be similar, and may feel like:

• Pain and pressure 
  • Between or behind the eyes (the sinus area)
  • Over the cheeks
  • Across the forehead
  • In the face
• Nasal congestion
• Runny nose
• Eye redness or tearing
• Eyelid swelling
• Symptoms may occur on one or both sides of the face

If a sinus headache is caused by a migraine, symptoms may also include:

• Prodrome, which are symptoms that occur 24 to 48 hours prior to the migraine
  • Increased yawning
  • Euphoria
  • Depression
  • Irritability
  • Food cravings
  • Constipation
  • Neck stiffness
• Aura 
  • Occurs in about 25% of patients with migraines before the headache
  • Flashing lights or bright spots
  • Zigzag lines
  • Changes in vision
  • Numbness or tingling in the fingers of one hand, lips, tongue, or lower face
  • Temporary muscle weakness 
  • Changes in speech
• Other symptoms
  • Nausea and vomiting
  • Sensitivity to light and noise
  • Sensitivity to touch, and normal activities (such as brushing the hair, shaving, or putting in contact lenses) may be painful

If a sinus headache is caused by a tension headache, symptoms may also include:

• Pressure or tightness around both sides of the head or neck
• Tenderness in the muscles of the head, neck, or shoulders

If a sinus headache is caused by sinusitis, symptoms may also include:

• Thick white, yellow, or green discharge from the nose
• Stuffy nose
• Pain in the teeth
• Fever
• Cough
• Problems smelling
• Ear pressure or fullness
• Bad breath
• Tiredness

What is called a sinus headache is usually not caused by sinus inflammation (sinusitis) but by migraines or tension headaches. Only about 3% to 5% of sinus headaches are actually caused by inflammation of the sinuses.

Other causes of sinus headache pain may include: 

• Temporomandibular joint (TMJ) syndrome
• Tooth clenching or grinding 
• Trigeminal nerve pain
• Temporal arteritis (associated with scalp pain, pain in the temple, jaw pain, and vision changes on one side)
• Dental infection
• Other neurologic causes of facial pain

Sinus headaches are diagnosed with a history and physical exam. The type of headache you have may be diagnosed by the type, frequency, and severity of symptoms. 

Tests used to diagnose the type or cause of the headache include: 

• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Nasal endoscopy
• Lumbar puncture for cerebrospinal fluid (CSF) analysis

Treatment for sinus headaches depends on the cause. 

If a sinus headache is caused by a migraine, treatment may include:

• Pain relievers
• Triptans
• Triptans combined with nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Antiemetics (anti-nausea medications)
• Lasmiditan (Reyvow), a selective serotonin 1F receptor agonist 
• Calcitonin-gene related peptide (CGRP) antagonists
• Ergots
• Neuromodulation 
• Transcranial magnetic stimulation (TMS) 
• Noninvasive vagus nerve stimulation 
• Opioids and barbiturates should not be used, except as a last resort 

If a sinus headache is caused by a tension headache, treatment may include:

• Pain relievers
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Acetaminophen
  • Pain relievers that contain caffeine
• Home remedies
  • Heat
  • Ice
  • Massage
  • Rest 
• Biofeedback

If a sinus headache is caused by sinusitis, treatment may include:

• Pain relievers
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Acetaminophen
• Saline nasal irrigation
• Intranasal glucocorticoids
• Intranasal saline spray 
• Intranasal ipratropium bromide 
• Oral decongestants 
• Intranasal decongestants 
• Antihistamines 
• Mucolytics such as guaifenesin 
• Antibiotics, if sinusitis is caused by bacteria (most cases of sinusitis are caused by viruses, and do not require treatment with antibiotics)