The patients prefer term “sinusitis headache” instead of “tension headache” because the former is ‘publicly’ acceptable. In fact, they may not have either of the headaches. The cause of headache may be something else. For example, the forehead pain may occur owing to common cold or blocked nose. So, it is the duty of otolaryngologist to find the true cause of the headache. The following valuable information will help the physician in distinguishing between a “sinusitis headache” and other headaches.

The retro-orbital headache is related to sphenoid sinusitis.

The maxillary sinus pain may radiate to the temples and canine teeth.

The ethmoid sinus pain occurs in the medial canthal, upper cervical, temporal and parietal areas.

A tension headache, a muscle contraction tension, may lead to tenderness of the scalp and facial muscles. During forehead percussion, pain may occur. The physician may confuse this pain with frontal sinusitis related pain.

In the frontal recess region, swollen agger nasi cells cause pain due to infection or obstructions.

The physicians shall have thorough understanding of drug rebound, cluster, muscle contraction, migraine and other headaches. Tension-type headache is a composite of muscular, neurogenic and vascular headache. The tension-type headache resembles to “tightness” or “pressing” pain. The pressure felt over the head, temples, forehead, shoulders and the neck. Anxiety and stress causes these headaches.

The cluster headaches are uncommon. The patients feel severe pain that begins suddenly and lasts about 45 minutes. The pain episodes occur several times in a day. They may also have facial flushing, nasal congestion and sweating.

A drug rebound headache, the bilateral frontal headache, is felt almost daily for the whole day. It is moderate to mild in intensity.

While treating a sinusitis headache, blocked area needs thorough examination instead of extent of the disease, because even small blockage can cause severe pain. A bunch of sensory nerve fibers may have accumulated around the sinuses ostia, causing lesions and blockage, and pain.

Involvement of the more than one paranasal sinus complicates the symptoms and pain. In these cases, pain spreads to different locations in the body. If the patient also has facial pain owing to other disorders, the confusion increases. The physician shall review headache history of the patient, exact location of the pain, type of the pain, headache frequency, factors worsening or improving the pain, and related sinus symptoms. The pain could be dull, mild, pulsating, severe, sharp, squeezing, stabbing, steady, vicelike, etc.

Barosinusitis may also cause dull ache in divers and flyers.