Headaches due to nasal and paranasal sinus disease.

Sinus infections are much less common today than they were in the preantibiotic era, but they still are overdiagnosed. Acute sinusitis, a relatively uncommon cause of headache, is the result of infection of one or more of the cranial sinuses. Acute sinusitis usually is characterized by purulent discharge in the nasal passages and a pain profile determined by the site of infection. Sinusitis is overdiagnosed as a cause of headache because of the belief that pain over the sinuses must be related to the sinuses. In fact, frontal head pain more often is caused by migraine and tension-type headache. It should not follow that if a patient fails to respond to treatment for migraine and tension-type headache one should reconsider the diagnosis of sinus disease. Whether or not nasal obstruction can lead to chronic headache is controversial. Paradoxically, sinus disease also tends to be underdiagnosed, as sphenoid sinus infection frequently is missed.