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Internal Medicine
2. Subacute worsening over days or weeks (tumor)
3. Disturbs sleep or present immediately upon awakening (tumor)
4. Abnormal neurological exam (space occupying lesions)
5. Fever or other unexplained systemic signs (meningitis)
6. Vomiting precedes headache
7. Headache induced by bending, lifting or cough
8. Known systemic illnesses
9. Onset of headache in patients older than 55 yrs.
Common Headache syndromes
1. Vascular headache
Vascular headaches refers to a group of headache syndromes, of unknown cause ,in
which pain results from dilation of one or more of branches of carotid arteries.
Migraine headache and cluster headache account for the majority of the cases.
A) Migraine Headache
Definition: migraine headache is a benign and episodic disease, characterized by
headache, nausea, vomiting and/ or other symptoms of neurological dysfunction.
It is the most common cause of vascular headache. It approximately affects 15% of
women and 6% men.
It usually begins in childhood or young adult life.
Etiology: the cause of migraine is often unknown, but several common precipitants have been
1) Family history of migraine present in nearly 2/3 of patients.
2) Environmental, dietary and psychological factors.
Emotional stress , depression
Altered sleep pattern or sleep deprivation
Menses , Oral contraceptives
Alcohol intake especially red wine
Caffeine withdrawal
Various food staffs ( e.g. . chocolates, nuts, aged , cheese , meals containing