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Diagnosis and treatment of rhinogenic headache in children are among the most difficult and controversial problems of modern otorhinolaryngology and pediatrics. Headache is one of the leading causes of medical care in childhood. However, the differentiation between primary cephalalgia and secondary rhinogenic pain presents significant diagnostic difficulties. The detection of morphological changes using computed and magnetic resonance imaging of the paranasal sinuses and endoscopic signs of inflammation does not always correlate with the clinical picture of pain syndrome, which often leads to unjustified surgical tactics. This paper aims to critically analyze the main contradictions in the current approach to the diagnosis and treatment of rhinogenic headache in children. A comprehensive review of the literature was conducted to identify the key pathogenetic mechanisms of pain syndrome in various forms of rhinosinusitis and nasal cavity contact deformities. Special attention was paid to the differential diagnosis of rhinogenic and non-rhinogenic pain etiologies, the criteria for selecting patients for surgical intervention, and the optimization of postoperative management. The results of the study highlight the need to revise the existing approach to the diagnosis and treatment of rhinogenic headache in children, implement a unified algorithm for interdisciplinary differential diagnosis, and develop clear criteria for selecting patients for surgical intervention.