OBJECTIVE: To describe a case of sphenoidal mucopyoceles as differential diagnosis of headache. CASE REPORT: Patient JLC, male, 61 years old with a history of oppressive headache, difficult to specification (non-frontal, non-temporal, non-occipital), localized pain in predominantly retro-orbital position. Evolution of about 6 months. No other symptoms. Consultation with a neurologist found no clinical and etiology. Symptoms improved partially with the use of AINEs or analgesics. About two months before to be found on our service, diplopia appeared - the neurologist then asked magnetic resonance imaging. Examination revealed an expansive mass in the sphenoid sinus with heterogeneous signal increased slightly hypointense on T1 and T2, without gadolinium uptake, with protrusion into the left nasal cavity and compression of the optic nerve at the orbital apex. Suggesting mucoceles of sphenoidal sinus. Taken to the operating room and performed drainage. Patient in postoperative monitoring symptomatic improvement so far.