Sinus Headache: Migraine in Sheep’s Clothing

Sinus Headache

Whilst ‘Sinus Headache’ is a common complaint in the general population (and this is promoted by the numerous, over-the-counter medications marketed for Sinus Headache), there is little evidence to support the sinuses as a common cause of disabling headache. Very few patients who present with ‘Sinus Headache’ have sinusitis. Furthermore, 80% of patients with nasal discharge have no headache or facial pain.


True Sinus Headache is rare.


Because Migraine and Tension Headache can present with facial and forehead pain respectively i.e. over the sinus areas, and nasal congestion and discharge, it is easy to diagnose ‘Sinus Headache’.


However, misdiagnosis of Migraine (as Sinus Headache) is common; various studies have shown between 90-80% of migraine patients are misdiagnosed with ‘sinusitis’, and unfortunately, the time taken to arrive at the correct diagnosis is often around 20-40 years! (yet around 60% are prescribed antibiotics for their ‘sinusitis’; not surprisingly, patients are dissatisfied, as migraine is not treated with antibiotics and symptoms continue7).

This is supported by surveys which show many patients’ headache or facial pain, persists after sinus surgery; and indicates that the ‘sinus’ pain was either Migraine or Tension-type Headache. There is now widespread agreement that sinus surgery should be avoided in the large majority of patients experiencing facial pain.


The underlying disorder in Migraine is a sensitised Brainstem. Therefore, it is not surprising that 82% of patients with self-reported sinus headaches, respond significantly to treatment with ‘triptans’ (specific migraine medication which abort migraine by DE-sensitising the Brainstem). Indeed, the positive effect of triptan medication on ‘Sinus Headache’ is often used to support a misdiagnosis of Sinus Headache.


Given that sinus issues are either absent, or, if present, are unlikely to cause headache or facial symptoms, that migraine specific medication (triptans) is effective in ‘Sinus Headache’, that unnecessary (unsuccessful) surgery is performed commonly, the inexcusable delay in ruling out sinusitis as the cause of headache, that the underlying disorder in Migraine and Tension Headache is a sensitised Brainstem and that neck disorders can sensitise the Brainstem, it seems logical that a skilled examination of the upper neck is included when investigating Sinus Headache.


A skilled examination of the upper neck can prevent unnecessary antibiotics (for many years!), and unnecessary surgery.


Identifying relevant upper cervical (neck) disorders in patients with ‘Sinus Headache’ presentations is relatively easy and is demonstrated by temporary reproduction of accustomed (‘sinus pain’) and resolution, as the examination (of the upper cervical spinal segments) technique is sustained.


If your sinus headache is not responding to  conventional medical treatment of sinus, then come and be assessed and see if your neck is responsible.