Rhinosinus-related headache

Wei-Ta Chen MD (Dr. Chen of Taipei Veterans General Hospital has no relevant financial relationships to disclose.)
Shuu-Jiun Wang MD, editor. (

Dr. Wang of the Brain Research Center, National Yang-Ming University, and the Neurological Institute, Taipei Veterans General Hospital, received consulting fees from Eli Lilly, Daichi-Sankyo, and Novartis.

Originally released February 14, 1994; last updated July 30, 2018; expires July 30, 2021

This article includes discussion of rhinosinus-related headache, sinus-related headache, and acute sinus headache. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


Rhinosinusitis-related headache is commonly diagnosed when patients have facial pain and pressure accompanying their headache. However, it is not as common as believed; the headache must accompany acute or chronic rhinosinusitis, a diagnosis that is based both on clinical and radiologic evidence. Many patients who are diagnosed with rhinosinusitis-related headache and treated with antibiotics may actually suffer from a primary headache, usually migraine. Differentiation between rhinosinusitis-related headache and migraine is of paramount significance. The author explains the key points and updates pertinent advances in differentiating between these 2 overlapped headache disorders.

Key points


• Many patients with a primary diagnosis of "sinus headache" have migraine or tension-type headache; the differential diagnosis depends on the patient's history.


• Uncomplicated sinusitis, other than sphenoid sinusitis, should be treated with a broad-spectrum oral antibiotic for 10 to14 days.


• Sphenoid sinusitis may be associated with major complications (bacterial meningitis, cavernous sinus thrombosis, etc.) and should be managed with high-dose intravenous antibiotics.


• Treatment failure and recurrent sinusitis are indications for neuroimaging and endoscopy to search for a source of obstruction in the sinus ostia and ostiomeatal complex.

Historical note and terminology

Sinusitis is defined as the inflammation of at least 1 of the paranasal sinuses, which are the air-filled cavities in the facial bones that are lined with pseudostratified ciliated columnar epithelium and mucous goblet cells (Gupta 2005).

Caldwell noted a functional relationship between the ostia of the sinuses and the development of sinusitis (Caldwell 1893). Hajek and associates emphasized that ostial stenosis was responsible for sinusitis (Hajek et al 1926). Hilding and Messerklinger demonstrated that ethmoid sinusitis is frequently a cause of frontal and maxillary sinusitis (Hilding 1950; Messerklinger 1978). Obstruction of the ostiomeatal complex, the common drainage pathway for the ethmoid, frontal, and maxillary sinuses, was later demonstrated to be involved in the development of sinus disease (McCaffrey 1993).

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