Up front about frontal headaches and sinusitis

In clinical practice frontal headaches are common however are frequently incorrectly attributed to rhinosinusitis. The misdiagnosis of frontal headaches and/or facial pain has been compounded by increased accessibility and over-reliance on sinus CT imaging. We reviewed the presentation and clinical findings of 3 patients in our unit with frontal headaches misattributed to rhinosinusitis. We also reviewed the literature regarding the diagnostic criterias for rhinosinusitis and the role/limitations of CT imaging in the diagnosis of paranasal sinus disease. All 3 patients had isolated frontal headaches in association with normal nasal examination. They had also undergone CT imaging with isolated frontal sinus opacification evident in 2 cases and frontal and maxillary opacification in the third. All failed medical therapy and when CT imaging was repeated, it was found to be normal. The combination of facial pain/headache alone and sinus opacification on CT imaging do not meet the criteria for either acute rhinosinusitis or chronic rhinosinusitis. Other symptomotolgy, CT and endoscopic findings need to be considered to prevent the incorrect diagnosis of rhinosinusitis and unnecessary surgical intervention. For those cases where the clinical presentation does not support a diagnosis of rhinosinusitis, repeat CT imaging and a neurology consultation may help in clarifying the diagnosis and deciding which patients really do need surgery.