Sinus headache is a common presenting complaint in the otolaryngology office. While most patients with this presentation are found to have migraine, many do not, and others fail therapy. This presentation focuses on case studies and the differentiation of migraine and rhinogenic headache –headaches that are caused or exacerbated by nasal or paranasal sinus pathology. The literature regarding this topic will be reviewed, along with a review of surgical series seeking to correct these abnormalities and the outcomes obtained with intervention. Suggestions will provide regarding correct diagnosis and management in an entertaining and interactive presentation.