Diagnosing Headaches

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Q. I take sinus medication for frequent sinus headaches, but it doesn't always help. Could it be a migraine instead? If it is a migraine, can sinus headache medication relieve this type of headache?

A. Headaches can present a maze of symptoms and there may be a of lot dead-ends before you find an answer. However, chances are your frequent sinus headaches are really migraines in disguise. At the 46th annual meeting of the American Headache Society, researchers presented data that pretty much confirmed what many headache specialists have suspected for years: Almost nine out of 10 people assumed to have sinus headaches were actually experiencing migraines. This is important because the treatment varies for both.

Add to that the spotty relief you get from sinus medication, and I'm even more confident that you’re a migraineur, someone who suffers from migraines.

But to get a definitive diagnosis of the type of headache that’s affecting you, you’ll need to provide your physician with specific information. What really helps is to keep a headache diary. Your doctor will need to know when (time of day, season, during menstrual cycle) and how often your headaches occur, what makes them worse, what makes them better, what seems to trigger them and how long they tend to last. Explain any other symptoms that accompany your headaches, too, such as sensitivity to light, nausea or seeing bright colors right before the head pain sets in.

While it is true that sinus and migraine headaches have overlapping symptoms, you need to know exactly what sort you’re dealing with to get the most relief. If you are suffering from migraines, for instance, the reprieve you get from sinus headache medication will likely be temporary. A migraine usually reappears an hour or two after popping sinus meds as the more extreme headache symptoms set in—the nausea, vomiting and sensitivity to light and sound. Does this pattern sound familiar to you?

Is it a migraine or a sinus headache?
Overlapping symptoms: May be triggered by weather changes May cause pain in similar areas of the head such as the forehead or around the orbits May include nasal drainage and tearing of the eyes
Main differences:
Migraine headaches	Sinus headaches
Migraine headaches can occur in patterns—triggered by seasons, smells, menstrual cycles, certain foods, flashing lights, alcohol and lack of sleep	Sinus headaches can follow a cold, flu or sinus infection (viral or bacterial) and are often triggered by air, pus or mucus that is trapped in the blocked sinuses
Migraines often run in families, and can reoccur on a regular basis	Sinus headaches can temporarily alter your sense of taste and smell
Migraines often cause a mild to severe throbbing pain on one side of the head	Sinus headaches often cause pain or pressure around the eyes, forehead or cheek
Migraines make you sensitive to strong light, odors, noise or even sudden movements	Sinus headaches are often accompanied by fever and chills, thick yellow or green mucus and swollen lymph nodes
About 20 percent of migraine sufferers have auras (visual changes which precede the migraine)	Many people with an acute sinus infection and headache have an achy feeling in their upper teeth
Often begin quickly, pain increases rapidly	Begin slowly, pain usually not as intense
Migraines often go away on their own in four to 72 hours	Sinus headaches can become chronic, causing pain for many weeks
Migraines often occur one or more times per month	Sinus headaches often occur one or more times per year

Although, as I said, some over-the-counter pain relievers used for sinus headaches, such as aspirin, acetaminophen or nonsteroidal anti-inflammatory drugs (or NSAIDs), may help to decrease migraine pain, they certainly don't offer the same level of relief that migraine-specific medications do. In fact, using sinus relief medications for migraines can be detrimental to some migraineurs’ health. The reason: It may lead to more headaches, which are called rebound headaches.

So, what should you do for migraines? The treatment often includes one or more of the following approaches:

Acute medications, which are used to treat a migraine once it occurs. Some examples include the highly effective category of medications known as the "triptans," as well as drugs to control the nausea such as metoclopramide.
Preventive therapies, which are drug treatments (such as beta-blockers or antidepressants) or non-drug approaches (such as biofeedback or acupuncture) to reduce both the number as well as the intensity of the migraines.
Rescue medications (such as intravenous or intramuscular injections of pain relievers or anti-nausea medications). These are more aggressive therapies used when the first two approaches don't work.

Sinus headaches, on the other hand, can occur when blockage keeps mucus from draining out of your sinus cavities. This results in a pressure build-up in those areas, leading to a deep and constant pain in the forehead, cheeks or bridge of your nose. You may even get swelling of your face, clogging of your ears, a fever and nasal discharge.

If you do end up being diagnosed with sinus headaches, the treatment will depend on the cause of the underlying infection. If it’s from a virus, we doctors often give medications to decrease the symptoms: pain relievers such as ibuprofen or acetaminophen, decongestants such as pseudoephedrine, anti-inflammatory nasal sprays containing corticosteroids or even allergy medications if allergies are increasing your nasal congestion. If your sinus headache is thought to be caused by a bacterial infection, we would also prescribe an antibiotic.

Primary care physicians tend to be really good at diagnosing and treating the different types of headaches. But if you find that you are not getting better and more consistent relief within a few months of treatment, ask for a referral to a headache specialist. These physicians have extra training in both the study as well as treatment of headaches. With the proper approach, headaches will no longer have the power to rule your life.

Read More About Headaches & Migraines on MSN Health & Fitness:

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)