Sinus Headaches
Sinus Headaches

Sinuses are air-filled spaces located in your forehead, cheekbones, and behind the bridge of your nose which drain through narrow channels into the nose. When the linings of the channels that connect the sinuses to the nose become inflamed, they impair the ability of the sinuses to drain normally. Pressure may begin to build up within the blocked sinus.

The swelling and inflammation then back up into the sinuses with increased mucus and fluid secretion. Pressure can also develop at contact points between two structures in the nose and sinuses that swell against each other. All of these factors can combine to create the pain of a sinus headache.

Cause of a Sinus Headache

A number of factors can cause a sinus headache, including:

  • Viral infection: Sinus inflammation, or sinusitis, may be caused by a viral infection, similar to a cold that causes swelling in the nose.
  • Nasal obstruction: Restricted airflow due to a deviated septum, enlarged turbinates, or nasal valve restriction can lead to pain, congestion, and a backup into the sinuses.
  • Allergies: The inflammation of the sinuses and decreased ability to drain can be caused by an allergic reaction like hay fever.
  • Bacterial infection: Once the sinuses are blocked and fill with fluid, they can harbor bacterial infections which thrive in the inflammatory conditions.


Sinus headaches are associated with a deep and constant pain, pressure and fullness in the cheekbones, forehead or bridge of the nose. The pain typically intensifies with sudden head movement, straining, or first getting up out of bed. The part of the face in the area of the affected sinus can be tender to the touch.

A sinus headache with a sinus infection can also have the following symptoms:

  • Greenish-yellow nasal discharge
  • Fever, chills, achy muscles
  • Postnasal draining which can cause a cough
  • Swollen glands in the neck

A sinus headache with sinus inflammation can also have the following symptoms:

  • Clear nasal discharge
  • Pain in the upper teeth (if the maxillary sinuses are inflamed)

Is it a Sinus Headache, Migraine, or Tension Headache?

Sinus headaches are easy to confuse with migraines and tension headaches because the signs and symptoms of the three overlap. Analyzing the location and duration of the pain along with other factors can help distinguish between them.

Location of Pain

  • Sinus headaches: Tend to be on both sides of the head above the eyebrows, behind the eyes and down the front of the face to the top of the mouth. If a person’s sinuses are clogged, they can be one-sided.
  • Migraines: Are often located on only one side of the head.
  • Tension headaches: Frequently feel like they’re all over the head or just in the temple and back of the head down the neck.

Duration of Pain

  • Sinus headaches: Seem to come out of nowhere and last, with varying levels of intensity, for hours, days, or even weeks.
  • Migraine pain: Can present suddenly or gradually and can last anywhere from one hour to two weeks.
  • Tension headache: Pain begins gradually and then slowly builds up. It typically resolves in a few hours.

Other Factors

  • Symptoms of sinus headaches: Include nasal congestion, sore throat, and feeling worse when lying down.
  • Symptoms of migraines: Include nausea, vomiting, extreme sensitivity to light, and experiencing auras (disturbance in sight or sound).
  • Symptoms of tension headaches: Include sore back, neck, and shoulders.

Sinusitis can often be a trigger for migraine and tension-type headaches. So, it can be very complicated when more than one type of headache is occurring in the same patient.

When to See a Doctor

See your doctor if you experience:

  • A fever higher than 100.5 F
  • A severe headache that does not respond to over-the-counter medicine
  • Symptoms that last longer than 5 to 7 days


When patients come in complaining of sinus pain and pressure, our initial discussions focus on the various types of headaches. We do extensive personal history research to discover if they are, in fact, experiencing sinus headaches.

We also discuss their breathing. Many people are unaware of how poorly they breathe. The relationship between breathing and the headaches, or the pressure, can be considerable.

Other diagnostic tools can include a CT scan of the sinuses and an endoscopy to look through air passages in the nose to where they drain into the throat and larynx (voice box).

Our Approach

The most important thing we try to avoid when treating people with sinus headaches is the use of powerful pain medicine. In some cases, the chronic use of pain medication can potentially contribute to a sinus headache. We seek instead to remove the source of the pain by optimizing sinus health.

We consider a sinus headache a single piece of a much bigger puzzle. Beyond simply treating the pain, our goal is to uncover how the sinus headache may be interrelated to any number of other sinus factors.

The reality is that sinus headache is typically arising from a combination of different factors in the nose and sinuses. These different parts feedback into each other. By building a picture of the entire sinus and breathing system, we can better address the underlying cause rather than a single symptom like sinus headaches.

Our goal is to optimize the functioning of the sinuses and the nose. Medical options may include a variety of topical treatment, nutritional supplements, allergy evaluation, and systemic medications. Cases that do not improve in response to medical treatment may benefit from surgical treatment. As an expert sinus surgeon, Dr. Mark Agrama offers both awake balloon sinuplasty and traditional endoscopic sinus surgery for his patients.