Despite popular belief, chronic rhinosinusitis is rarely the cause of chronic headache or facial pain. Many patients who report facial pain are therefore mistakenly given this diagnosis. Instead, they may be suffering from a myofascial pain syndrome, such as midfacial segment pain. These syndromes share similarities with tension-type headache. Medical therapy, including a low-dose tricyclic antidepressant, can be beneficial to many patients. The Sinonasal Outcome Test and Brief Pain Inventory-Facial can be used to assess patients and monitor treatment response. Those whose symptoms are refractory to medical therapy may benefit from adjunctive treatments such as regional anaesthesia or neuromodulation. We also present our experience of setting up a multidisciplinary facial pain clinic.