This document discusses the differences between tension-type headaches and migraines, as well as common symptoms associated with migraines that are often misattributed to sinus issues. Tension-type headaches are more common in the general population while migraines are more prevalent in medical clinics due to their greater severity. True sinus headaches are uncommon. Many migraine symptoms like sinus pain, pressure, congestion and watery eyes are often mistaken for sinus problems but are actually part of the migraine experience. Proper diagnosis is important to deliver effective treatment.

1. The Headache
Dilemma …

2. Tension-type Headache or Migraine?
*People who want to talk to the doctor about their headaches or who have headaches that interfere with daily activities.
Lipton RB et al. Neurology. 2003;61:375-385.
40
12
44
29
12
75
0
10
20
30
40
50
60
70
80
Tension-Type Headache Migraine
Population
Waiting Room
Significant Headaches*

3. Episodic Tension-type Headache
1. Number of days with such headache < 180/year (<15/month)
2. Headache lasting from 30 minutes to 7 days
3. At least 2 of the following:
1. Pressing/tightening (non-pulsating) quality
2. Mild or moderate intensity (may inhibit, but does not prohibit activities)
3. Bilateral location
4. No aggravation by walking stairs or similar routine physical activity
4. Both of the following:
1. No nausea or vomiting (anorexia may occur)
2. Photophobia and phonophobia are absent, or one but not the other is present
5. At least 10 previous headache episodes fulfilling these criteria
6. No evidence of organic disease

4. Migraine Without Aura
1. Headache lasting from 4 to 72 hours
1. At least 2 of the following
– Unilateral location
– Pulsating quality
– Moderate or severe intensity
– Aggravation by routine physical activity
2. At least 1 of the following:
– Nausea and/or vomiting
– Photophobia and phonophobia
3. At least five attacks fulfilling these criteria
1. No evidence of organic disease

5. Migraine Aura
1. Positive Neurological Symptoms
– Reversible brain/neurological symptoms
• Visual flashes, spots, or zig-zag lines
• Traveling tingling sensations
– Gradual development over >4 minutes
– Resolves within 1 hour
1. Negative Neurological Symptoms
– Reversible brain/neurological symptoms
• Visual blind spots
• Numbness
• Speech or word finding problems
• Trouble thinking
– Resolves within 1 hour

6. Neck Pain During Migraine
1. Prevalence
– 75% of subjects
2. Descriptions
– 69% - tightness
– 17% - stiffness
– 5% - throbbing
– 5% - other
82% had previously been given a
diagnosis of tension-type headache
61%
92%
41%
0%
20%
40%
60%
80%
100%
Prodrome Migraine
Phase
Postdrome

7. “Sinus Symptoms” Are Common in the Presentation of Migraine
N = 2424
“Sinus” Symptoms
0% 20% 40% 60% 80% 100%
27%Itchy Nose
38%Watery Eyes
40%Runny Nose
63%Nasal Congestion
82%Sinus Pain
84%Sinus Pressure
25%Vomiting
29%Aura
67%Phonophobia
79%Photophobia
85%Worsened by Activity
89%Pulsatile
97%Moderate/Severe Pain
IHS Migraine Symptoms
Schreiber C. Poster presented at: American Headache Society Meeting; June 21-23, 2002;Seattle, WA.

8. Summary
• Tension-type headaches are very common in the general population
• Migraine headaches are also common but are more common than tension-type headaches in medical clinics because of
greater severity and disability
• True “sinus headaches” are uncommon
• Sinus symptoms and neck pain are very common symptoms of migraine
• Most cases of recurrent “sinus headaches” are migraine especially if there is a family history of recurrent or chronic
headaches

9. Reference
David M. Biondi, DO
Director, Headache Management Programs
Spaulding Rehabilitation Hospital
Consultant, Massachusetts General Hospital
Instructor in Neurology, Harvard Medical School
Boston, MA
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