Middle turbinate sinonasal headache syndrome is a rare but not uncommon treatable cause of headache. The true incidence of headache from this cause is unknown. Pneumatization (concha bullosa) or hypertrophy of the middle turbinate can result in it contacting the septum or the lateral nasal wall and may give headaches in the periorbital region. It may occur in the absence of inflammatory sinus disease. The clinical history, nasal endoscopic examination and, coronal CT-scan should point towards the diagnosis and a local anaesthetic challenge test should confirm the diagnosis. Treatment is by relieving the contact point by medical or surgical means. Twenty-one cases of middle turbinate sinonasal headache syndrome refractory to medical treatment are presented with emphasis on the results of endonasal endoscopic surgical treatment.