Migraine vs sinus headache?
Last updated September 3, 2026.
Most self-diagnosed sinus headaches are migraines. A true sinus headache is rare and rides on an active infection: thick colored discharge, face pressure, fever, after a cold. Migraine: throbbing, often one-sided, worse with movement, with nausea and light sensitivity, recurring without any infection. Migraine's dirty trick is autonomic: it can water an eye and stuff a nostril on the headache side, which feels sinus-y. The sorting questions: repeated attacks with clear sinuses between (migraine) versus only-when-sick (maybe sinus); colored discharge plus fever (infection) versus nausea plus dark-room-seeking (migraine); bending-forward pressure (sinus) versus movement-worsened throb (migraine). The label matters because the treatments do not overlap: antibiotics do nothing for migraine, and triptans taken early do. Red flags hold regardless of label: thunderclap onset, fever with stiff neck, new weakness or vision change, all ER. And if you have treated "chronic sinus" for years without infection findings, ask about migraine; that question regularly ends years of wrong treatment.
What to do
- Recurring attacks, clear sinuses between: migraine.
- Thick discharge plus fever: actual sinus infection.
- Antibiotics do not treat migraine; triptans do.
- Thunderclap, stiff neck, weakness: ER.
- Years of "sinus headaches": ask about migraine.
Related questions
- How long does a migraine last?
- Can an online doctor prescribe migraine medication?
- How long does a sinus infection last?
- When should you go to the ER for a headache?
