Headache or Facial Pain/Pressure in Rhinosinusitis: Subtle Clinical Patterns

OBJECTIVES: To describe the prevalence and clinical characteristics of headache or facial pain/pressure among patients presenting with rhinosinusitis in otolaryngology practice and to identify associated clinical findings. METHODS: We retrospectively reviewed 304 patients with rhinosinusitis at a tertiary otolaryngology center. Among these patients, headache or facial pain/pressure was assessed in 202 cases with available documentation and analyzed in relation to symptom severity, sinus computed tomography, and nasal endoscopic findings. Multivariable analysis identified factors independently associated with headache or facial pain/pressure. RESULTS: Among the 202 patients, 42.1% reported headache or facial pain/pressure considered related to sinonasal inflammation. High-intensity facial pain/pressure was uncommon, with 6.5% reporting high SNOT-22 scores. Active migraine at presentation was rare (1.0%), and a history of migraine (10.4%) was comparable to the general population. In multivariable analysis with false discovery rate adjustment, middle meatal polyps were associated with lower odds of headache or facial pain/pressure (OR: 0.41; 95% CI: 0.19-0.92; adjusted p = 0.032). A maxillary sinus Lund-Mackay score of 2 showed a positive association in unadjusted analysis (OR: 1.49; 95% CI: 1.08-2.04; p = 0.007) but was not significant after correction (adjusted p = 0.056). Headache or facial pain/pressure was not assessed in 102 of the 304 patients. CONCLUSION: Headache or facial pain/pressure is common but often mild in patients with rhinosinusitis in otolaryngology practice. Variability in symptom assessment may contribute to differences in reported prevalence, highlighting the importance of systematic inquiry combined with endoscopic and radiologic evaluation.