Preventing Misdiagnosed of Headache in Chronic Rhinosinusitis: Diagnostic Challenges and Referral Implications : A Case Report and Literature Review

Abstract

Background: Headache is often associated with chronic rhinosinusitis (CRS); however, it is non-specific and frequently overlaps with primary headaches, leading to potential misdiagnosed. Case Illustration: A 48-year-old male presented with chronic headache for two months accompanied by long-standing nasal obstruction. The headache worsened with bending forward and physical activity. Rhinoscopic examination revealed hyperemic mucosa and bilateral nasal discharge. Head CT scan showed no intracranial abnormalities but demonstrated a lesion in the left maxillary sinus consistent with chronic rhinosinusitis. Discussion: Literature indicates that most cases labeled as “sinus headache” are actually primary headaches. Headache due to rhinosinusitis is typically characterized by facial pressure, worsening when bending forward, accompanied by nasal symptoms, and should be confirmed by objective findings such as endoscopy or CT scan. Conclusion: Headache cannot be used as a sole diagnostic criterion for chronic rhinosinusitis. A comprehensive approach is essential to prevent misdiagnosed and improve referral accuracy