Headaches and facial pain are common complaints. In many cases patients are referred to an otolaryngologist to determine if head pain is sinus related. In the absence of other nasal or sinus symptoms, some rhinogenic headaches can be overlooked or misdiagnosed. A complete history and thorough ENT examination, including nasal endoscopy, with or without coronal CT scans, is the key to the correct diagnosis. Subtle exploratory findings such as minimal inflammatory changes or anatomic abnormalities of the ostiomeatal complex area may cause pressure resulting in facial pain. When medical treatment fails to produce sustained relief, surgery may be considered. Current worldwide thinking firmly supports the endoscopic endonasal approach as a safe and effective form of treatment in patients with nasal and sinus disease. We prospectively assessed 67 patients who underwent FESS for rhinogenic facial pain in the absence of other nasal or sinusal symptoms. The overall success rate was 93%. Only 5.9% of our cases had some minor complications. No major complications occurred.