A true sinus headache produces steady pain and pressure in your cheeks, forehead, or the bridge of your nose, and it almost always comes with nasal symptoms like congestion, thick discolored mucus, or a reduced sense of smell. If you have head pain without those nasal signs, what you’re feeling is probably not a sinus headache at all. In fact, studies show that roughly 60% of people who believe they have sinus headaches actually have migraines.
What a Sinus Headache Feels Like
The pain is mild to moderate and steady, not pulsing or throbbing. It centers in specific spots: across your cheekbones, above your eyebrows, along the bridge of your nose, or deep behind your forehead. Many people also feel an ache in their upper teeth, because the roots of those teeth sit just below the maxillary sinuses.
Two physical cues help distinguish sinus pain from other headaches. First, the pain gets noticeably worse when you bend forward or lie down, because those positions increase pressure inside inflamed sinus cavities. Second, pressing on the skin over your cheekbones or just above the inner corner of your eyebrows will feel tender or sore. If bending forward doesn’t change your pain and your face isn’t tender to touch, a sinus problem is less likely.
Nasal Symptoms Are the Key Clue
Head pain alone doesn’t make a sinus headache. The defining feature is what’s happening in your nose at the same time. A genuine sinus headache is caused by inflamed, swollen sinuses, and that inflammation produces a specific set of nasal symptoms:
- Thick, discolored mucus. Yellow or greenish discharge from the front of your nose or dripping down the back of your throat (postnasal drip).
- Congestion. A blocked or stuffy feeling that makes it hard to breathe through one or both nostrils.
- Reduced sense of smell. Foods and scents seem muted or absent.
You may also notice ear pressure, bad breath, fatigue, a cough (especially when lying down), or a low-grade fever. These symptoms typically follow a cold or upper respiratory infection by several days. If your headache appeared without any preceding cold or congestion, it’s worth considering other causes.
Why It’s So Often Confused With Migraine
Migraines can produce pressure around the eyes and cheeks, congestion, and even a runny nose, which is why so many people mistake them for sinus headaches. A systematic review pooling data from eight studies found that 59% of patients who came in describing a “sinus headache” actually met the diagnostic criteria for migraine.
A few differences can help you sort this out. Migraines tend to throb or pulse, often concentrate on one side of the head, and frequently come with nausea, sensitivity to light, or sensitivity to sound. Sinus headaches produce steady (not pulsing) pressure on both sides, and they always involve thick nasal discharge and congestion. If your “sinus headaches” keep coming back without a cold, last less than a day, or respond to migraine medication, they’re likely migraines.
Timeline: Viral vs. Bacterial Sinus Infection
Most sinus headaches start during a viral infection, like a common cold, and improve within five to seven days as the virus runs its course. If your symptoms persist beyond seven days, or actually get worse after an initial week of improvement, a bacterial infection may have developed on top of the original viral one. Bacterial sinus infections often last seven to ten days or longer and are the type that sometimes require antibiotics.
Chronic sinusitis is a separate situation. If you’ve had nasal congestion, facial pressure, drainage, and a decreased sense of smell for 12 weeks or more, that meets the clinical threshold for chronic sinusitis. Diagnosis at that point typically requires a doctor to confirm ongoing inflammation, often with a nasal examination or imaging.
A Simple Self-Check
You can run through a quick mental checklist to gauge whether your headache is sinus-related:
- Location: Is the pain in your cheeks, forehead, or bridge of your nose (not the top or back of your head)?
- Bending test: Does the pain increase when you lean forward?
- Tenderness: Does pressing on your cheekbones or forehead feel sore?
- Nasal discharge: Do you have thick, yellow or green mucus?
- Congestion: Is your nose blocked?
- Recent cold: Did these symptoms follow an upper respiratory infection?
If you answer yes to most of these, a sinus headache is a reasonable explanation. If you have head pain but no nasal symptoms, or if your headaches come and go without colds, migraine or tension-type headache is a more likely cause. Getting the right diagnosis matters because the treatments are completely different: decongestants and nasal rinses for sinusitis, versus specific migraine therapies for misidentified “sinus headaches” that keep returning.