Migraine vs sinus headache?

Here is the plot twist that headache specialists repeat constantly: most self-diagnosed "sinus headaches" are actually migraines. The confusion is understandable because migraine can cause face and forehead pain, watery eyes, and a stuffy or runny nose on the headache side, all of which feel sinus-y. The real split: a true sinus headache is rare, rides on an active sinus infection (thick colored discharge, face pressure that worsens bending forward, fever, reduced smell, symptoms past 10 days or double-worsening after a cold), and resolves when the infection does. Migraine: throbbing, often one-sided pain, worse with movement, lasting 4 to 72 hours, with nausea, light and sound sensitivity, and sometimes an aura, recurring in attacks without any infection in sight. The sorting questions: do you get these repeatedly with normal sinuses between episodes (migraine), or only when genuinely congested and sick (maybe sinus)? Is there thick colored discharge and fever (infection) or clear drainage with light sensitivity and nausea (migraine)? Does bending forward worsen face pressure (sinus) or does lying still in a dark room feel mandatory (migraine)? Why the label matters: antibiotics and endless decongestants do nothing for migraine, while triptans taken early in an attack work, and frequent attacks earn prevention. One caution in the other direction: assuming every head pain is migraine can miss the rare dangerous one, so the red flags hold regardless: sudden worst-ever headache, headache with fever and stiff neck, or new weakness or vision changes mean the ER. And if you have been treating "chronic sinus" for years without infection findings, ask a doctor about migraine specifically: that conversation regularly ends years of wrong treatment.