Sinus Headache: Causes, When to Worry, Treatment

Sinus Headache — Causes, When to Worry and Treatment

Most headaches blamed on the sinuses turn out to be migraine. How to tell the difference, what pain behind the eyes can mean, the warning signs that need urgent care, and what helps. Explained by a Sydney neurologist.

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When Pain Behind the Eyes or in the Face Needs Urgent Care

Most headaches felt behind the eyes, across the forehead or in the cheeks are not dangerous. A few patterns need care straight away, so they come first.

Call 000 — or go to an emergency department — if

a headache comes on suddenly and severely and reaches its worst within a minute (the worst headache of your life), even if it then eases
the headache comes with fever and a stiff neck, a rash that does not fade when pressed, confusion or unusual drowsiness
an eye becomes painful and red, especially with blurred vision, halos (coloured rings) around lights, or nausea and vomiting
there is swelling or redness around the eye and the eye bulges, hurts when you move it, or you have double vision or blurred vision, especially during a cold or sinus infection
the headache comes with sudden loss of vision (even if brief), double vision, a new drooping eyelid or one pupil larger than the other, slurred speech, sudden severe dizziness or unsteadiness, or numbness or weakness of the face, an arm or a leg
the headache started after a head injury and is getting worse, comes with vomiting, drowsiness or confusion, or you take blood-thinning medicine
the headache comes with a seizure

A sudden, explosive headache can mean bleeding around the brain (a subarachnoid haemorrhage). A painful red eye with blurred vision and halos can mean a sudden rise in the pressure inside the eye (acute angle-closure glaucoma), which can permanently damage sight if it is not treated quickly. A bulging, painful eye during a sinus infection can mean the infection has spread into the eye socket (orbital cellulitis). Weakness, trouble speaking or a sudden loss of vision can mean a stroke. A new drooping eyelid or a change in the size of one pupil can mean pressure on a nerve from a bulging blood vessel (an aneurysm) or a tear in the wall of an artery in the neck (a dissection). Fever with a stiff neck can mean meningitis. A seizure with a headache needs urgent checks for a cause in the brain. All need urgent treatment. If you already know you have cluster headache, a red, watering eye, a drooping eyelid or a smaller pupil on that side during your usual attacks are part of it and settle afterwards; a first attack, an attack that is different, blurred vision or halos, or eye signs that stay after the attack still need urgent care. Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.

See your GP the same day if

it is a new headache and you are over 50, especially with a tender scalp, pain in the jaw when you chew, or feeling generally unwell
there is pain in or behind one eye that is worse when you move the eye, with blurred or dim vision or colours that look washed out
there is swelling or redness of the eyelids or around the eye, without the warning signs above
a rash of small blisters appears on one side of the forehead or around one eye, often after 2 or 3 days of burning or tingling pain there
during a sinus infection, the headache becomes severe or keeps getting worse, or a soft swelling appears on the forehead
the headache is getting steadily worse over days or weeks, or is worst on waking, with vomiting
the headache is brought on by coughing, sneezing, laughing or straining, or comes with a whooshing sound in the ears in time with your heartbeat
you have a fever with the headache
you have cancer or a weakened immune system
you are pregnant or have had a baby in the last few weeks; with blurred vision or sudden swelling of the face or hands, contact your maternity unit or go to hospital now

If you cannot see your GP that day, go to an emergency department. If vision is lost suddenly, call 000.

Where most people sit

These patterns are uncommon. Most pain behind the eyes, across the forehead or in the cheeks is migraine, tension-type headache or a cold or sinus infection: common conditions that do not damage the brain and can be treated. If you are worried about a brain tumour: in a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have one, and tumours usually cause other symptoms too, such as weakness, seizures, a change in personality, or a headache that gets steadily worse over weeks.

Is It Really Your Sinuses?

The pain sits across the forehead, in the cheeks and behind the eyes. The nose feels blocked or runs, and the eyes water. It comes on when the weather changes, or in spring. It is easy to conclude that it is the sinuses. Usually it is not.

In a US study of 100 adults who were sure they had sinus headaches, 86 turned out to have migraine or probable migraine, and only 3 had headaches caused by their sinuses. A larger US study of nearly 3,000 people with "sinus" headaches, diagnosed by themselves or by a doctor and with no sign of infection, found migraine-type headache in 88%. So why does migraine feel so much like sinus trouble?

The answer is in the wiring. One nerve, the trigeminal nerve, carries feeling from the forehead, the eyes, the cheeks and the lining of the nose and sinuses. It is also the main pain pathway of migraine, which is why migraine is usually felt at the front of the head: the forehead, the temples and around the eyes. The same pathway switches on a reflex that blocks or runs the nose and makes the eyes water. It is a little like a fire alarm wired to the sprinklers: when the pain system fires, the nose and eyes react too, even though nothing is wrong with them.

The researchers behind the first study summed up why the mistake is made as "guilt by provocation, location, and association". What sets the headache off, where it hurts and what comes with it all seem to point to the sinuses, and all three fit migraine just as well:

What sets it off. Among those who had migraine, changes in the weather set off the headaches in 83%, the change of seasons in 73% and contact with allergens, such as pollen or dust, in 62%. These are migraine triggers too.
Where it hurts. Three in four felt the pain over the cheeks, and six in ten across the forehead and cheeks on both sides.
What comes with it. More than half had a blocked nose with their headaches, a third had puffy eyelids, a quarter had a runny nose, and about one in five had red or watery eyes.

Where most people sit

If your "sinus headaches" keep coming back without a fever or thick, discoloured mucus, migraine is the most likely explanation. That is useful to know: migraine is common, does not damage the brain, and has its own effective treatments. Sinus treatments do not treat it.

Why Is the Pain Behind My Eyes?

Pain behind the eyes is one of the most common ways a headache is felt, because the nerve that carries feeling from the eyes and the front of the head is the same one these headaches use. These are the usual causes.

Migraine. The most common cause of headaches that keep coming back. The pain is often around or behind one eye, but can switch sides or affect both. It is usually throbbing, moderate to severe and worse with activity, lasts 4 to 72 hours, and comes with nausea or a dislike of light and noise. Some people see flashing lights or zigzag lines before the headache: see migraine aura.
Tension-type headache. Pressure or tightness on both sides, often across the forehead and around the eyes, after a long day, stress or poor sleep. It is mild to moderate, does not throb, and you can usually carry on with your day.
Cluster headache. Much less common than migraine, and very severe: pain in, around or behind one eye, on the same side throughout a bout, lasting 15 minutes to 3 hours, from once every other day to 8 times a day, in bouts that last weeks or months. On the same side the eye turns red and waters, the nostril blocks or runs, and the eyelid can droop or swell. People pace or rock rather than lie still. It is three times more common in men and usually starts between 20 and 40. The eye signs settle after each attack; a first attack like this, or one that is different from your usual attacks, needs same-day assessment in an emergency department. Read more about cluster headache.
Eye strain. A headache after long spells of reading or screen work that eases when you stop. Uncorrected eyesight causes headaches much less often than is generally believed, but an eye test is worthwhile if headaches follow close work, especially in children.

Where most people sit

Most pain behind the eyes that keeps coming back is migraine or tension-type headache. Cluster headache is far less common, and it has its own specific treatments once it is recognised.

Sinus Infection, Migraine, Tension-Type or Cluster Headache?

These features help tell the four apart. Thick, discoloured mucus and a fever point to a sinus infection; the other three do not cause them.

Swipe the table sideways to compare all four →

Feature	Sinus infection	Migraine	Tension-type headache	Cluster headache
Comes with	Thick, discoloured mucus from the nose or down the throat, a blocked nose, a reduced sense of smell; sometimes a fever	Nausea, a dislike of light and noise; often a blocked or runny nose and watery eyes	Usually nothing else; no more than mild nausea	On the side of the pain: a red, watering eye, a blocked or runny nostril, a drooping or swollen eyelid; restlessness
Where it hurts	Cheeks, forehead or around the eyes, sometimes the upper teeth; worse bending forward	Forehead, temples, and around or behind the eye; often one side, but can be both	Both sides: pressure across the forehead or around the head	Strictly one side: in, around or behind the eye, or the temple
How long	Days to a few weeks; goes as the infection clears	4 to 72 hours, in attacks that keep coming back over months or years	30 minutes to 7 days	15 minutes to 3 hours, up to 8 a day, in bouts lasting weeks or months
Feels like	Pressure or a dull ache; tender over the sinuses	Throbbing, moderate to severe, worse with activity	Pressing or tightening, mild to moderate	Very severe; often described as a hot poker behind the eye
Brought on by	A cold or other infection	Weather changes, the seasons, sleep loss, missed meals, hormonal changes, alcohol	Stress, tiredness, poor sleep, long hours at a desk	During a bout, alcohol can set off an attack

When it is the sinuses. A sinus infection (acute rhinosinusitis) usually follows a cold. The face aches or feels full over the cheeks, the forehead or around the eyes, often worse when you bend forward, with a blocked or runny nose, thick discoloured mucus, a reduced sense of smell and sometimes a fever. The pain rises and falls with the infection and goes as it clears, and most sinus infections settle on their own. Headaches that keep coming back, month after month, without a fever or discoloured mucus, are much more likely to be migraine.

Long-term sinus inflammation (chronic sinusitis, lasting more than 12 weeks) mainly causes a blocked nose, a reduced sense of smell and pressure in the face. Whether it causes ongoing headache has long been debated, and sinus changes on a scan are common in people without headaches, so a scan on its own does not prove the sinuses are behind a headache.

Where most people sit

The table is a guide, not a diagnosis. The features overlap, and many people have more than one kind of headache. All four are treatable, and sorting them out is the main job of the consultation.

The Less Common Causes Doctors Look For

A few conditions cause pain behind the eyes or in the face and need their own treatment. Each is uncommon, and each usually has a pattern that gives it away.

Acute angle-closure glaucoma, a sudden rise in the pressure inside the eye. The eye becomes painful and red, vision blurs, halos appear around lights, and nausea and vomiting are common. It is an emergency: go to an emergency department, because sight can be permanently lost without quick treatment.
Optic neuritis, inflammation of the nerve that carries vision from the eye to the brain. Pain in or behind one eye that is worse when the eye moves, with blurred or dim vision and colours that look washed out, coming on over several days. It can be the first sign of multiple sclerosis and needs prompt assessment. Vision often recovers over weeks or months.
Giant cell arteritis, an inflammation of the arteries of the scalp. A new headache after 50, often at the temples, with a tender scalp, pain in the jaw when chewing and feeling unwell. It is treated urgently to protect the eyesight.
Infection spreading from the sinuses. Rarely, a sinus infection spreads into the eye socket, causing swelling and redness around the eye, a bulging eye, pain on moving the eye, or double vision. It is an emergency. Very rarely, it spreads to the brain or its linings, causing a severe, worsening headache, drowsiness or confusion.
Raised pressure of the fluid around the brain (idiopathic intracranial hypertension). A headache, often with a whooshing sound in the ears in time with the heartbeat, and swelling of the nerve at the back of the eye that the doctor can see. It is most common in women of child-bearing age, and needs prompt assessment because it can affect sight.
Trigeminal neuralgia. Brief, severe, electric-shock pains on one side of the face, lasting seconds to up to 2 minutes, set off by light touch, chewing, talking, brushing the teeth or a breath of cold air. Read more about trigeminal neuralgia.
Trochlear headache. Pain at the upper inner corner of the eye socket, above and behind the eye, that is worse when you look up or down, with a tender spot there. It is uncommon, and an injection at that spot can ease it.

Where most people sit

These causes are uncommon, and most announce themselves: a red eye, a change in vision, pain on moving the eye, swelling around the eye, or a new headache after 50. A careful history and examination, including a look at the back of the eyes, usually tell the doctor whether any of them is possible.

How Is the Cause Found?

Most of the time the cause is found from your story and an examination. Tests are for when the pattern raises a question.

Your story. Where the pain is and where it spreads, how long it lasts, how often it comes, what sets it off, what comes with it (a blocked or runny nose, discoloured mucus, fever, nausea, a dislike of light), and how often you take pain relief or sinus tablets.
The examination. A full neurological examination, including your vision, pupils and eye movements and the back of the eyes, and tenderness over the sinuses and the scalp.
A sinus scan, only when the story points to the sinuses. Sinus changes are common in people without headaches, so a scan cannot prove on its own that the sinuses are the cause. An ear, nose and throat (ENT) specialist can look inside the nose with a thin camera (nasal endoscopy) when sinus disease is likely.
An eye check, when an eye cause is possible. An optometrist or an eye specialist (ophthalmologist) can measure the pressure in the eye and check your vision and the nerve at the back of the eye.
Blood tests or an MRI scan, when they fit. For example, tests for inflammation when giant cell arteritis is possible, or an MRI scan when optic neuritis is.

A few weeks of a headache diary (when the pain came, where it was, what came with it, what you took) often makes the pattern clear.

How to Get Rid of a Sinus Headache

The right treatment depends on the cause, which is why the diagnosis comes first. These help most people.

If it is migraine, treat it as migraine. Sinus medicines do not treat migraine. Migraine has its own treatments for attacks, and preventive medicines when attacks are frequent: see our migraine overview.
Keep pain relief to two or three days a week at most, including cold-and-flu and "sinus" tablets that contain pain relief. Taking it on too many days (15 or more days a month for simple pain relievers, 10 or more for some others) can itself keep headaches going. In the US study of people sure they had sinus headaches, about 1 in 10 were taking pain relief so often that it was probably keeping their headaches going: see medication overuse headache.
If it is a sinus infection. Most settle on their own. Salt-water nasal sprays or rinses and simple pain relief can ease the symptoms. See your GP if the symptoms are severe or getting worse, have not started to improve after about 7 to 10 days, or keep coming back; only some sinus infections need treatment for the infection itself.
For tension-type headache. Regular breaks from the screen, regular sleep, exercise and ways to manage stress reduce how often it comes.
For cluster headache. It needs a doctor: it has its own specific treatments, both to stop attacks and to prevent bouts. See cluster headache.
For eye strain. An eye test, and regular breaks from close work.

Where most people sit

Most people improve once the cause is clear and the treatment matches it. For many people with "sinus headaches", that means recognising migraine, cutting back on sinus tablets and pain relief, and treating the migraine itself.

When to See a Neurologist About Sinus Headaches or Pain Behind the Eyes

"Sinus headaches" keep coming back without a fever or discoloured mucus
Sinus treatments have not helped
Attacks of severe pain behind one eye
You are taking pain relief or sinus tablets on many days a month
You are not sure whether it is your sinuses, migraine, tension-type headache or something else
A new headache after 50 (see your GP the same day first)
You want a clear diagnosis and a plan

A consultation involves a detailed history, a neurological examination and a plan: working out which headache, or headaches, you have, arranging tests only when the result will change what happens next, and coordinating with your GP and, when needed, an ENT or eye specialist. Dr Ron Granot trained at Prince of Wales Hospital, Sydney, and sees patients in Bondi Junction. For the wider picture, read our migraine overview.

Frequently Asked Questions

Is it a sinus headache or a migraine? +

Usually migraine. In studies of people who were sure they had sinus headaches, most turned out to have migraine. A sinus infection usually comes with thick, discoloured mucus, a blocked nose and sometimes a fever, and the pain goes as the infection clears. Headaches that keep coming back without a fever or discoloured mucus, especially with nausea or a dislike of light, are much more likely to be migraine, even with a blocked or runny nose.

Can I have sinus pressure without a blocked nose? +

You can feel pressure there, but it is rarely the sinuses. Pressure across the forehead, between the eyes or in the cheeks, without a blocked nose or discoloured mucus, is most often migraine or tension-type headache. A sinus infection usually comes with nose symptoms: a blocked or runny nose, mucus and a reduced sense of smell.

What causes a headache behind the eyes? +

Most often migraine or tension-type headache. Cluster headache causes very severe attacks of pain behind one eye. Eye strain, a sinus infection and, rarely, eye conditions such as acute glaucoma or optic neuritis can also cause it. A painful red eye with blurred vision, or a bulging eye that hurts to move during a sinus infection, needs an emergency department.

Why is the pain only behind one eye? +

Migraine is often one-sided, though it can switch sides. Cluster headache is always one-sided, usually on the same side throughout a bout, lasts 15 minutes to 3 hours, and comes with a red, watering eye and a blocked or runny nostril on that side. Pain behind one eye that is worse when you move the eye, with blurred or dim vision, can be optic neuritis and needs your GP the same day.

When should I worry about a headache behind my eyes? +

Call 000 or go to an emergency department if it comes on suddenly and reaches its worst within a minute; if an eye becomes painful and red with blurred vision or halos around lights; if an eye bulges or hurts to move during a sinus infection; or if it comes with fever and a stiff neck, sudden loss of vision, double vision, weakness or slurred speech. See your GP the same day if it is a new headache after 50, especially with a tender scalp or jaw pain when you chew.

How do I get rid of a sinus headache? +

It depends on the cause. If it is migraine, migraine treatment helps, and sinus medicines do not. A sinus infection usually settles on its own, and salt-water rinses and simple pain relief ease the symptoms. Keep pain relief, including cold-and-flu and sinus tablets, to two or three days a week at most, because using it more often can keep headaches going.

Can eye strain cause a headache behind the eyes? +

It can, but less often than most people think. A headache from eye strain comes after long spells of reading or screen work and eases when you stop. An eye test is worthwhile if that is the pattern, especially for children. Headaches that keep coming back with nausea or a dislike of light are more likely to be migraine.

Could a headache behind my eyes be a stroke or a brain tumour? +

Very unlikely, when headache is the only symptom and it has come and gone before. A stroke usually comes on suddenly with weakness or numbness of the face, an arm or a leg, trouble speaking or loss of vision, and a sudden, severe headache that peaks within a minute can mean bleeding around the brain: call 000 for either. In a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have a brain tumour.

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. If you have a sudden, severe headache that peaks within a minute, a painful red eye with blurred vision, an eye that bulges or hurts to move during a sinus infection, a headache with a stiff neck and fever, or a headache with weakness, loss of vision, slurred speech or unsteadiness, call 000. Diagnosis and treatment decisions are made on an individual basis with your treating doctor.

Sinus Headaches That Keep Coming Back?

Book a consultation with Dr Ron Granot — neurologist with a special interest in headache, Bondi Junction. Ask your GP for a referral, then get in touch.

Book a Consultation

Call Us02 9388 0615

LocationSuite 301, Bondi Junction

Emailreception@eastneurology.com.au

Last reviewed: 17 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.