11.5.2 Headache attributed to chronic or recurring rhinosinusitis


Headache caused by a chronic infectious or inflammatory disorder of the paranasal sinuses and associated with other symptoms and/or clinical signs of the disorder.

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. Clinical, nasal endoscopic and/or imaging evidence of current or past infection or other inflammatory process within the paranasal sinuses
  3. Evidence of causation demonstrated by at least two of the following:=
    1. headache has developed in temporal relation to the onset of chronic rhinosinusitis
    2. headache waxes and wanes in parallel with the degree of sinus congestion and other symptoms of the chronic 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 diagnosis.

It has been questioned whether chronic sinus pathology can produce persistent headache. Recent studies seem to support such causation. However, pathological changes seen on imaging or endoscopy correlating with the patient’s pain description are not on their own enough to secure the diagnosis of 11.5.2 Headache attributed to chronic or recurring rhinosinusitis.