Headache is prevalent in the population, however, its diagnosis and treatment has always been a great challenge in clinical practice. Otolaryngologists often encounter patients who visit the clinic for headaches, and it is difficult to correctly identify rhinogenic headaches from other causes of headaches. Misdiagnosis of rhinogenic headache may result in unnecessary surgical treatment, leading to increased medical costs for the patient and unrelieved or even worse headache symptoms. Sinus-related headache – not a medical term – is more accurately known as rhinogenic headache. We tend to diagnose rhinogenic headaches when headache sufferers also have symptoms of sinus disease such as facial pain and pressure. However, over the past decade, we have gained a better understanding of the modalities and etiology of facial pain and pressure, and based on experience, the diagnosis is more likely to be migraine rather than rhinogenic headache, even if the patient also has symptoms such as nasal obstruction and fluid. According to the diagnostic criteria for chronic sinusitis established by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the diagnostic criteria for migraine established by the International Headache Society (IHS), the presence of facial pain or pressure symptoms alone cannot be diagnosed as chronic sinusitis, and also, chronic sinusitis may cause headache or facial pain only during acute attacks. How to differentiate rhinogenic headache from migraine Head and neck examinations are essential for patients diagnosed with “sinus-related headache”, including nasal endoscopy, CT examination, neurological examination and IHS migraine diagnostic criteria. According to the evaluation results, the actual diagnosis of migraine is more likely in patients with “sinus-related headache”, and in a small percentage of patients with definite sinus disease on nasal endoscopy and CT examination, the diagnosis of acute or chronic sinusitis can be made and treated accordingly. Treatment of migraine and “sinus-related headache” Patients with “sinus-related headache” without sinus pathology on nasal endoscopy or CT examination should be treated with migraine medication, such as sumatriptan, and referred to neurology. For patients with no abnormal findings on nasal endoscopy and CT examination, but positive headache reaction after local anesthesia at the nasal contact point and ineffective treatment with migraine medication, surgery can also be considered. 3. Migraine and “sinus-related headache” can coexist Sinusitis and migraine can coexist, which poses a greater clinical challenge. Several studies have analyzed the association between CT findings and sinus symptoms, and while some studies have shown a correlation between the severity of CT lesions and the severity of facial pressure, most studies have shown no correlation between the two.