Headache and facial pain-the role of the paranasal sinuses: a literature review.

Long neglected as a clinical entity, sinus headache has become a common complaint of patients with facial pain. Although pain is associated with some sinus disease, many experts feel the magnitude and instances of sinus headache have been exaggerated to the public. Birt stated that "otolaryngologists see scores of patients with vague discomfort in the forehead, between the eyes, and across the nose and cheeks." Patients invariably ascribe their symptoms to sinus disease, and are later surprised to discover that they are not infected. In fact, chronic sinusitis is not particularly common, and many headache patients with autonomic features will probably have muscle tension headaches or migraines. Most authors feel that acute or chronic headache processes are not a result of overt paranasal sinus disease. However, the clinician is obliged to consider the possibility in differential diagnosis. This paper will present the anatomic, neurologic, physiologic, and pathologic aspects of paranasal sinus disease and its conceivable relationship to headache and facial pain.