Headache is very common and it has many different causes. It can be a challenging, difficult, and interesting diagnostic problem. The knowledge of the complex sensory innervation of the ear, nose and paranasal sinuses is important. Heterotopic or referred pain must be differentiated from homotopic pain that is experienced at the point of injury. The nervous pathways of heterotopic otalgia are shown. From the otolaryngologist's point of view, there are multiple causes for the frequent symptom of facial pain and headaches: headaches due to ear diseases: pain extending to the ear region, with special regard to "referred otalgia" involving the cranial nerves V, IX, X; facial pain due to temporomandibular dysfunction; rhinological causes of facial pain and headaches, including posttraumatic trigeminal neuralgia and "facial sympathalgies"; the syndrome of the elongated styloid process. The quality of pain of the most common rhinological and otological diseases is reported. A detailed history and a carefully performed and focussed physical and laboratory evaluation will aid in the complex differential diagnosis.