Facial pain and "sinus pain"
Most facial pain attributed to "the sinuses" turns out to be something else. Identifying the real cause is the first step to effective treatment.
Facial pain is one of the commonest reasons patients reach a rhinology clinic, often after months of treatment for "sinusitis" with little benefit. The most useful fact to know early: pain on its own, without nasal blockage, discharge or a change in smell, is rarely sinusitis. Pain with a red eye, swelling, vision change or fever needs urgent assessment.
Common non-sinus causes
- Midfacial segment pain: constant pressure across the cheeks and forehead with a normal nose examination
- Migraine, which can localise to the cheek or behind the eye and is frequently misread as sinus pain
- Cluster headache and related one-sided headaches with a watering eye or blocked nostril on the same side
- Jaw joint (TMJ) problems, dental causes and trigeminal neuralgia
Why the distinction matters
Sinus surgery does not relieve non-sinus facial pain, and several of these conditions have very effective specific treatments that only work once the right diagnosis is made.
Assessment and treatment
The history carries most of the diagnosis: the pattern, the triggers and what comes with the pain. Examination includes the nose with a small endoscope, the face and jaw, and a brief neurological check; a CT scan helps when there are nasal symptoms and is unhelpful when there are none. Most causes are treated in this clinic, including medication for midfacial segment pain, migraine and the rarer one-sided headaches, with onward referral reserved for complex or unresponsive cases.
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This page is general information and not a substitute for individual medical advice.