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11.5.1 Headache attributed to acute rhinosinusitis


Headache caused by acute rhinosinusitis and associated with other symptoms and/or clinical signs of this disorder.

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. Clinical, nasal endoscopic and/or imaging evidence of acute rhinosinusitis
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to the onset of rhinosinusitis
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with worsening of the rhinosinusitis
      • b) headache has significantly improved or resolved in parallel with improvement in or resolution of the rhinosinusitis
    3. headache is exacerbated by pressure applied over the paranasal sinuses
    4. in the case of a unilateral rhinosinusitis, headache is localized and ipsilateral to it
  4. Not better accounted for by another ICHD-3 diagnosis1.

1. Migraine and 2. Tension-type headache can be mistaken for 11.5.1 Headache attributed to acute rhinosinusitis because of similarity in location of the headache and, in the case of migraine, because of the commonly accompanying nasal autonomic symptoms. The presence or absence of purulent nasal discharge and/or other features diagnostic of acute rhinosinusitis help to differentiate these conditions.


Pain due to pathology in the nasal mucosa or related structures is usually perceived as frontal or facial, but may be referred more posteriorly. Simply finding pathological changes on imaging of acute rhinosinusitis, correlating with the patient’s pain description, is not enough to secure the diagnosis of 11.5.1 Headache attributed to acute rhinosinusitis. Treatment response to local anaesthesia is compelling evidence, but may also not be pathognomonic.

An episode of 1. Migraine may be triggered or exacerbated by nasal or sinus pathology.