Diagnostic Dilemma of Sinus Headache and Migraine

This review article aims to clarify and elucidate how to diagnose correctly sinus headache by discussing sinus headache as regards to its epidemiology, clinical picture, radiological investigations, as well as its medical and endoscopic management. The article also will clarify the relationship between a sinus headache and other co-morbidities, namely migraine, facial pain, and allergy, and the differential diagnosis of sinus headache. That sinus headache is not indicating life-threatening health problem, not a common disease, and usually is overrated. Usually the patient and sometimes the physician will attribute the patient’s facial pain to a sinus headache, while in fact it is caused by another pathological condition. Sinus headache is better to be diagnosed by exclusion and to be confirmed by nasal endoscopy before rushing into its treatment. Although it is neither sensitive nor specific in cases of chronic rhinosinusinusitis, plain X-ray is beneficial in the diagnosis of acute rhinosinusitis. Computed tomography (CT) is recommended, but it is not conclusive and it is important to know that a CT scan may remain abnormal even after endoscopic sinus surgery. Magnetic resonance imaging (MRI) is excellent and it is the choice option wherever possible. Pharmaceutical treatment of sinus headache should be addressed first before adopting surgery option; and if functional endoscopic sinus surgery (FESS) is chosen, which is the most common type of surgery used, preoperative assessment is very important to reduce complications.