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Sinuses are made of delicate bony passages lined with an even more delicate nasal tissue. Normally the passages should be open and air can travel in and out of the sinuses from higher to lower pressure. Air inside the sinuses, inside the nose and outside of the nose should all be at about the same pressure. The problem comes when one or more of the passages swells and becomes blocked. High pressure can usually get out of a sinus, but low pressure can further swell the nasal lining which can cause pain, increased mucus production, possibly bleeding and predispose you to a sinus infection. This is why you should never scuba-dive with sinus congestion and it is wise to take precautions when flying if you feel your sinuses aren't working correctly.
Your sinus cavities are just that, spaces in your head filled with air and sometimes fluid. When the outside air pressure drops, the air trapped inside your sinuses wants to escape, putting pressure on your head and causing pain. The easiest way to tell if sinuses are causing your head pain is to press on them to feel if pain is localized there.
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Much like when your ears "pop" when flying or when there are changes in elevation, there is an equalizing of pressure that takes place between the hollow space behind your ear and your nose. Sinuses are very similar in the fact that unless the pressure is equal both in the sinus and in your nose, this difference in pressure may cause pain. For normal sinuses the pressure can often equalize on its own but when the passage way between the sinus and the nose becomes blocked or is not large enough, the pressure will build up causing increased pain and pressure.
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