An Unusual Presentation of Frontal Pneumosinus Dilatans as Flight-Related Headache With Favorable Response to Carbamazepine.

Pneumosinus dilatans (PSD) is an uncommon disorder marked by an abnormal hyperpneumatization of a paranasal sinus with intact bony walls. Although it is usually asymptomatic, it can cause headaches or other pressure-related symptoms, especially during changes in barometric pressure. We report a case of isolated frontal PSD in a 28-year-old man who complained of recurring, pressure-like frontal headaches that only occurred during air travel. The clinical examination, diagnostic nasal endoscopy, and neurological assessment were unremarkable. High-resolution computed tomography indicated hyperaeration of the frontal sinus with intact bony walls, which is consistent with PSD frontalis. Conventional treatments for barosinusitis, such as topical and systemic decongestants, were ineffective. Given a probable neuropathic pain mechanism caused by altitude-related pressure changes, carbamazepine medication was started, resulting in considerable symptomatic improvement and long-term pain relief at six months. The present case demonstrates PSD as an unusual but relevant differential diagnosis in flight-induced headaches, and it suggests that neuropathic pain modulators may play a role in certain patients.