Sinus pain: is it real?

Associations between facial pain, headache, sinusitis, and nasal anatomical abnormalities have long been of clinical interest, but there are very few clinical studies on those subjects. According to survey of the literature from a recent 12-month period, studies have found that patients with chronic sinusitis have typical and predictable patterns of headache and facial pain. After surgical treatment of chronic sinusitis, facial pain and headache tended to improve after 2 months, but at 1 year after surgery many patients had developed recurrent pain. There is evidence that ostial obstruction of the frontal sinus can cause frontal headache. Theoretically, the pathophysiologic mechanism of pain from ostial obstruction could also explain the pain associated with some anatomical abnormalities and mucosal contact points. In a large series, 10% of patients seen in a nasal clinic had neurologic origins of facial pain with no evidence of sinusitis. There have been isolated reports of endoscopic sinus surgery being successful for patients with limited sinus disease and facial pain, but many senior surgeons advise significant caution when considering surgery in those patients because of high long-term failure rates and the eventual identification of other causes of the pain in many cases.