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Sinus pain, pressure under the eyes, and maybe a little congestion are a common occurrence for you.  You’re in good company; an estimated 4 million Americans are treated for recurrent sinus infections and sinusitis (an inflammation of the sinuses) and countless others are self-diagnosed.  Unfortunately, the term “sinus headache” is actually indicating two separate conditions which have similar symptoms.  Do you know which one you are really suffering from?

First, a little background.  Sinuses are hollow air spaces in your head that exchange air and mucous with the nose.  There are four pairs of sinuses; frontal (over your eyes in the brow area), maxillary sinuses (inside each cheekbone), ethmoid sinuses (just behind the bridge of your nose and between your eyes), and sphenoid sinuses (behind the ethmoids in the upper region of your nose and behind your eyes).  Pain that is located in one or more of these areas is generally attributed to a sinus headache.

The first condition is a secondary headache that is actually caused by a primary problem – your sinuses.  If you have a sinus infection, you will probably have a headache.     Additionally, you may have feelings of pressure in your face or under your eyes because air or mucous trapped in the sinuses puts pressure on the sinus wall.  To be correctly diagnosed, however, you should also have at least one more of the following: yellow, green, or gray nasal discharge, blockage, fever, fatigue, dental pain, cough, bad breath, ear pain or fullness, and a diminished sense of smell. This infection requires the use of an antibiotic, and so must be diagnosed by a physician.  Sinusitis simply means an inflammation of your sinuses.  This can be caused by a common cold or allergies and asthma.  The symptoms and diagnosing criteria are similar, but any nasal discharge is clear.  Sinusitis without an infection is typically treated with allergy medication, decongestants, and analgesics like Tylenol to reduce the headache pain.  Sinusitis, with or without infection, can become a chronic condition lasting 3 to 8 weeks or even years.

Surprisingly, most of those who have chronic sinus headaches actually have a primary headache disorder - migraines.  A recent study found that of 2,524 people with self or physician diagnosed sinus headaches, a full 90 percent actually were suffering from migraines.  There are a couple of reasons for this.  One is that the person may have had a sinus infection in the past that presented with similar headache pain or they know that they have allergies.  They then continue to treat any future symptoms the same way that they had before.  Some relief is felt, because the over the counter analgesics contained in most “sinus” products relieve some or most of the pain.  Doctors can get confused as well.  Migraine pain can occur in the face and create a feeling of fullness under the eyes and congestion, but is often not included on the diagnosing criteria for migraines.  Chronic sinusitis can cause recurrent headaches, so the frequency of the symptoms can be misleading.  The problem is that the treatment for a true sinus headache is different from that for migraine and can actually cause a worsening migraine condition or rebound headaches, not to mention frustration for the headache sufferer.

How do you tell which condition you have?  First, make sure that your symptoms fulfill the criteria for sinusitis.  Then keep a headache diary.  Note the times and places when the headache occurs and how you feel before, during, and after the headache.  If analgesics alone do not always stop the headache completely or sleeping provides the best relief, migraine is probably the culprit.  If you believe that you have an allergic sinusitis, but prescription allergy medicine does not prevent the headache, it is probably not a sinus headache.  Family history is the best indicator of migraine – over 90 percent of migraine sufferers have a relative that has similar headaches.  If in doubt, ask your doctor to prescribe migraine medication from the triptan class for you to try.  It won’t hurt and if they work, then you have your answer.