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Headache, Sinusitis, and Migraine - An Approach to Diagnosis

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Headache, Sinusitis, and Migraine - An Approach to Diagnosis

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Trigeminal migraine is a persistent pain disorder that impacts the trigeminal nerve responsible for transmitting sensations from the face to the brain.

Written by

Dr. Abid Khan

Medically reviewed by

Dr. Sneha Kannan

Published At July 15, 2019
Reviewed AtDecember 19, 2023


A common and frequently inconvenient condition that affects people of all ages and backgrounds is headache. Headaches are defined as pain or soreness in the head or neck area. They can be minor to severe and include other symptoms like light sensitivity, nausea, or trouble focusing. Numerous factors, such as stress, strain, dehydration, sinus congestion, or underlying medical conditions, can cause them. It is believed by physicians and patients as well that when symptoms of pressure or pain are present over the cheeks and around the eyes, then it is a sinus headache. It makes sense as well, but surprisingly, most of the patients (around 60 to 70 percent) that land in ENT (ear-nose-throat) clinic as "sinus headaches," turn out to be trigeminal migraines.

What Are the Symptoms?

Numerous symptoms can accompany a headache, and identifying the particular characteristics of the headache can aid in determining its type and possible causes. The following are typical headache symptoms:

1. Pain or Discomfort: Headache people experience pain or discomfort in the head or neck area. There can be variations in the pain's intensity, duration, and location.

2. Types of Headaches:

  • Tension-Type Headache: A tension-type headache is characterized by a persistent, tightening, or pressing pain that can occur on either side of the head.

  • Migraine Headache: A migraine headache is usually characterized by throbbing or pulsating pain, usually on one side of the head, along with light and sound sensitivity and nausea.

  • Cluster Headaches: Cluster headaches are episodes of severe pain, usually centered around one eye, that are intermittently relieved.

3. Related Symptoms:

  • Vomiting and nausea are frequent side effects of severe tension-type headaches and migraines.

  • Photophobia (light sensitivity) and phonophobia (sound sensitivity) are common symptoms of migraines.

  • Before the headache stage, some migraine sufferers have visual or sensory abnormalities, or auras.

4. Trigger Factors: Headaches can be brought on by a variety of situations or behaviors, such as stress, sleep deprivation, certain foods, hormonal fluctuations, or outside influences.

5. Intensity: Headaches can vary in intensity from minor pain to excruciating agony.

6. Physical Symptoms: While sinus headaches can be linked to facial pressure and congestion, tension-type headaches can induce tension in the muscles of the neck and shoulders.

What Is Trigeminal Neuralgia?

  • One of the main nerves responsible for facial sensation is the trigeminal nerve, which is affected by the chronic pain disorder known as Trigeminal neuralgia.

  • While the specific cause of this condition remains unknown, it is thought to be caused by compression or irritation of the trigeminal nerve.

  • It might occasionally be associated with diseases like multiple sclerosis or other structural problems with the brain.

  • The onset of pain is unilateral, sudden, severe pricking pain with brief episodes. Trigger factors include touching the face, exposure to cold climates, etc.

  • The trigger factors are present along the path of the Trigeminal nerve.

What Is Trigeminal Migraine?

Criteria for migraine, according to the International Society of Headache are:

  • Episodic, recurrent headache lasting four to 72 hours with any two of these pain qualities - unilateral pain may be throbbing or pulsating in nature.

  • Pain worsens on movement.

  • Moderate to severe pain.

In addition to any of these associated symptoms:

  • Nausea.

  • Vomiting.

  • Light and sound sensitivity.

Trigeminal migraines are different than other migraine headaches, as the trigeminal nerve supplies the forehead, cheeks, ear, and around the eyes. As the trigeminal nerve also supplies the mucous glands in the nasociliary lining, and ear as well, the symptoms of runny nose, congestion, etc. are also experienced in trigeminal headaches. Ear symptoms include blockage of the ear and tinnitus.

How Is the Diagnosis Made?

A combination of physical examination, medical history assessment, and, in certain situations, diagnostic tests is used to diagnose migraines, sinusitis, and headaches. The usual process for diagnosing each is as follows:

Headache Diagnosis:

  • Medical History: The doctor will inquire about the headache's characteristics, including its location, intensity, duration, and any accompanying symptoms.

  • Physical Examination: A comprehensive examination might involve neurological evaluations and a look for any indications of additional underlying medical issues.

  • Diagnostic Tests: For tension-type headaches, there is typically no need for specialized testing. To rule out other conditions, the healthcare provider may order imaging tests or blood tests if the headache pattern changes or if there are concerning symptoms.

Diagnosis of Sinusitis:

  • Medical History: The doctor will inquire about symptoms such as pressure in the face, headaches, runny nose, and discharge from the nose, taking into account how long the symptoms were present and how they have progressed.

  • Physical Examination: The nose, throat, and sinuses may be examined. Tenderness over the sinuses is frequently the area of focus.

  • Diagnostic Tests: Imaging studies like a CT (computed tomography) scan or MRI (magnetic resonance imaging) may be ordered in severe or chronic cases, though they are not always required to confirm the diagnosis or identify complications.

Diagnosis of Migraine:

  • Medical History: The doctor will investigate the features of the headaches, including the throbbing pain, length, and causes, as well as any accompanying symptoms like light or sound sensitivity or nausea.

  • Physical Examination: To evaluate reflexes, coordination, and sensory perception, a neurological examination may be carried out.

  • Diagnostic Tests: The symptoms and medical history are the main factors used to diagnose migraines. To rule out other conditions, however, imaging studies or other tests might be requested if there are unusual features or doubts regarding the diagnosis.

How Is Trigeminal Migraine Treated?

Once the diagnosis of trigeminal migraine is confirmed, antibiotics have no role in the management of trigeminal migraine. Telemedicine portals can be used to take an online prescription for migraine and an in-office visit to the doctor can help to get a prescription. Medications to relieve migraines are:

  1. Propranolol.

  2. Metoprolol.

  3. Amitriptyline.

  4. Botox.

  5. Timolol.

  6. Divalproex.

  7. Valproate.

  8. Topiramate.

Foods to avoid during migraine headaches:

  1. Alcohol.

  2. Yeast products.

  3. Caffeine.

  4. Chocolates.

  5. Nitrate preservatives.

Non-food triggers to avoid are:

  1. Anxiety.

  2. Too little or too much sleep.

  3. Hunger.

  4. Exercise.

  5. Travel.

  6. Dehydration.


In conclusion, trigeminal neuralgia is characterized by abrupt and severe episodes of facial pain without the typical migraine symptoms, whereas trigeminal migraines are a type of migraine headache with specific migraine features. Both conditions involve the trigeminal nerve and can cause facial pain. A medical professional's precise diagnosis is essential to figure out the best course of action for each condition.

Frequently Asked Questions


How Is a Sinus Headache Diagnosed?

Sinus headaches are diagnosed by observing the presenting symptoms. The patients have a fever, stuffy nose, thick and colored mucus nasal discharge, fullness in the ear, swollen and puffy face, cheek pain, forehead pain, and pain in the bridge of the nose. The pain worsens when the individual moves the head or while bending forward.


How to Self-Differentiate Between a Sinus Headache and a Migraine?

It is quite easy to confuse a sinus headache and a migraine since both cause facial pain, nasal congestion, and a runny nose. It may be possible to differentiate between both by marked differences in the pigmentation of the nasal discharge. The discharge is usually clear in migraines and is discolored and thick, along with fever in sinus headaches borne from sinus infections.


Is It Possible to Have Both Migraine and Sinus Headaches Simultaneously?

Sinus headaches are basically migraines occurring during a sinus infection. These require dual-phase treatment as the first phase is focused on dealing with cranial and facial pains while the next phase is to clear the sinus infections. Hence, it is possible to have migraines during sinus infections.


How Is a Migraine Diagnosed?

Migraine is preliminarily diagnosed by tracking the events, which is then referred to a specialist to exclude any underlying conditions. CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, blood chemistry, urine analysis, sinus X-rays, EEG (electroencephalogram), ocular exams, and spinal taps can be ordered by the concerned specialists to diagnose any underlying pathology or a migraine.


What Primarily Causes Sinus Headaches?

Sinus headaches are primality borne out of sinus infections. These cause pain and pressure changes within the skull. Rhinovirus infections (common cold) and allergies are the most common reasons for sinus infections and associated pains. Alternatively, sinus headaches can also be migraines with secondary nasal symptoms.


How Does One Feel With a Sinus Migraine?

Sinus migraines are associated with cold, nasal congestion, and discolored-thick nasal discharge. Individuals have to deal with facial and cranial pains and blocked ears. The face might get swollen, and the patients might feel pressure around the eye sockets, cheeks, and forehead.


Is It Possible to Trigger Migraine With Sinusitis?

Sinus congestion due to sinusitis can increase the pressure within the skull and cause facial pain. Sinusitis can also trigger migraines. Usually, nasal symptoms are secondary to migraine headaches and not vice-versa. In such cases, the prime focus is to relieve the pain, as antibiotics do not provide any relief.


How to Determine a Possible Cranial Spread of a Sinus Infection?

Sinuses are one of the easiest highways to the brain. Untreated infections can reach the brain, causing encephalitis. This is seen as headaches, fevers, and fatigue, along with serious symptoms like hallucinations, paralysis, seizures, and loss of consciousness.


What Is the Time Span of a Sinus Migraine?

Sinus migraines may begin hours or days before the actual headache event and last for another few hours to days. Usually, migraines should not last beyond two days. Sinus headaches can last for longer periods based on the severity of the primary sinus infection.


What Can Be Done to Stop Sinus Migraines?

Certain methods can be recruited to deal with sinus migraines, including
- Warm compresses on the face.
- Using decongestants.
- Using saline nasal sprays or drops.
- Using a vaporizer or steam inhalation.
- Using antihistamines.
- Analgesics.
- Steroids to reduce inflammation.
- Specific migraine treatment protocol.


What Is the Best Medication for Sinus Headaches?

The primary treatment for a sinus headache is to reduce and remove the pain caused by intra-sinusoidal pressure build-up, which over-the-counter medications like Acetaminophen and Ibuprofen can do. Other migraine management drugs like Sumatriptan, Ergotamine, and Rizatriptan may also be included with proper medical consultation.


Is It Possible to Have Sinusitis Without a Blocked Nose?

Sinus infections do not tick all the listed symptoms in every individual. So, it is quite possible to have sinusitis without a stuffy or blocked nose. This especially holds true if the individual bears a history of allergies or other sinus problems.


What Is a Neurologist’s Opinion on Migraines?

Migraine is a neurological condition, and a neurologist is the best specialist to confirm the diagnosis. This is done by first tracking the events and associated lifestyle choices. The neurologist might order a range of tests to exclude any underlying pathology before circling over a final migraine diagnosis.


Which Is the Fastest Cure for Migraine?

Each individual has a different way of dealing with a migraine attack or event. For some, dark and silent environments help relieve the pain; some require cold compressions over the neck or face; some might benefit from small caffeine drinks; some find sleep therapeutic; exercise might be analgesic for some, while yet others might need pharmacotherapy. A wide range of activities has been reported as therapeutic and analgesic to migraine, including sex, chocolate, certain foods, or drinks.


What Condition Can Look Like Sinusitis?

Sinusitis shares its presentation with many other conditions, including the common cold, allergies, migraine headaches, chronic daily headaches, myofascial pain, temporomandibular joint or jaw pain, rhinitis medicamentosa, and even sleep apnea.
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Dr. Abid Khan
Dr. Abid Khan



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