What a true sinus headache feels like
Sinus headaches arise from inflamed, blocked sinuses and cause pain and pressure in the face: over the cheeks, around or behind the eyes, in the forehead and sometimes the upper teeth. The pain worsens when you bend forward or lie down and is accompanied by nasal congestion, thick coloured discharge, reduced smell and sometimes fever. Most “sinus headaches” diagnosed by patients are actually migraine or tension headaches. See sinus headache and sinus infection symptoms.
Why pain at the back of the head is rarely sinus
The frontal, maxillary and ethmoid sinuses are in the front of the skull. Only the sphenoid sinus lies deep behind the nose, and sphenoid sinusitis can refer pain to the top or back of the head, but it is uncommon and usually comes with other signs. Pain at the base of the skull is much more likely to be muscular, from the neck, or from nerves and blood vessels. Treating the sinuses will not help if they are not the cause.
More likely causes of back-of-head pain
- Tension-type headache: a band-like pressure, often with tightness in the neck and shoulders, linked to stress, posture and screen time. See dizziness and headache.
- Cervicogenic headache: pain from the neck joints or muscles spreading up to the back of the head, aggravated by neck movements.
- Occipital neuralgia: sharp, shooting or electric pain at the base of the skull and scalp, with tenderness over the nerve.
- Migraine, which can be felt at the back of the head, often with nausea and light sensitivity.
- Poor posture and eye strain, including long hours at a screen.
- Teeth grinding and TMJ problems. See jaw clicking when chewing.
- High blood pressure, particularly severe, with a morning occipital headache.
- Whiplash, neck injury or arthritis.
- Rarely, bleeding, tumours, infection and other serious causes.
When sinus problems might contribute
- You have nasal congestion, thick yellow-green discharge, reduced smell and facial pressure.
- Headache worsens when bending forward and eases with nasal decongestion.
- It follows a cold, lasts more than 10 days or you have a fever.
- You have known chronic sinusitis, nasal polyps or a deviated septum.
- A CT scan or nasal endoscopy shows sinus disease.
- Even then, back-of-head pain may be a combined picture with tension or migraine.
What helps at home
- Take paracetamol or ibuprofen as directed; avoid taking painkillers on more than 2–3 days a week to avoid medication-overuse headache.
- Apply heat to the neck and shoulders, and gently stretch the neck.
- Check posture: keep your screen at eye level and take breaks every 30–45 minutes.
- Stay hydrated, eat regularly and keep a consistent sleep schedule.
- Manage stress with breathing, exercise and relaxation. See deep breathing for anxiety.
- If nasal congestion is present, use saline rinses and steam. See sinus pressure relief.
- Limit caffeine and alcohol.
- Keep a headache diary.
Medical treatment
- Physiotherapy for neck-related and tension headaches.
- Migraine treatments (triptans, preventives) when appropriate.
- Nerve blocks or medicines for occipital neuralgia.
- Treatment of sinus infection or chronic sinusitis if present.
- A dental review for grinding, with a night guard.
- Blood pressure control.
- Imaging (CT or MRI) for atypical, progressive or red-flag headaches.
Red flags
- Sudden, severe “worst ever” headache.
- Fever with stiff neck, rash or confusion.
- Headache after a head injury.
- Weakness, numbness, speech or vision changes.
- Headache that wakes you from sleep or is worse on coughing or straining.
- A new headache after age 50, or in people with cancer or weakened immunity.
- Swelling around an eye with sinus symptoms.
When to see a doctor
- Headaches more than twice a week or increasing.
- Painkillers needed most days.
- Headaches with nasal symptoms lasting more than 10 days.
- Neck stiffness, arm numbness or tingling.
- Headaches affecting work or sleep.
- Any red flag above.
Three common situations
An office worker with a dull band of pain at the back of the head by afternoon: tension headache; posture, breaks and neck stretches.
A person with sharp, shooting pain at the base of the skull: consider occipital neuralgia; see a doctor.
A person with a cold, face pressure and fever and also a headache at the back: sinus infection may contribute; see a doctor if beyond 10 days.
Key points to remember
Pain at the back of the head is rarely from the sinuses. Think tension, neck, nerves and migraine, and treat accordingly. Seek urgent care for sudden severe headache or neurological symptoms. Our ENT team can check your nose and sinuses if sinus disease is suspected.
This guide is for general information and does not replace an examination by your own doctor, dentist or ENT specialist.
Questions about sinus headache at the back of the head
These answers are general information and do not replace an examination or individual medical advice.
Can sinus problems cause pain at the back of the head?
Rarely; only the deep sphenoid sinus can refer pain there, and it is uncommon.
What causes a headache at the back of the head?
Tension, neck problems, occipital neuralgia, migraine and posture are the usual causes.
How do I know if it is a sinus headache?
Facial pressure, congestion, thick discharge and worsening on bending forward point to sinuses.
What helps a tension headache?
Heat, neck stretches, posture changes, hydration, rest and simple pain relief.
When should I worry?
With sudden severe pain, fever and stiff neck, neurological symptoms or head injury.
Will a decongestant help?
Only if sinus congestion is the cause.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.