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518 SecTioN iii Neurology aNd Special SeNSeS ` neurology—PAthology Neurology aNd Special SeNSeS ` neurology—PAthology

Headaches Pain due to irritation of structures such as the dura, cranial nerves, or extracranial structures. More
common in females, except cluster headaches.
ClAssiFiCAtion loCAliZAtion durAtion desCriPtion treAtment
Cluster a Unilateral 15 min–3 hr; Excruciating periorbital pain Acute: sumatriptan, 100% O .
2
repetitive (“suicide headache”) with Prophylaxis: verapamil.
lacrimation and rhinorrhea.
May present with Horner
syndrome. More common in
males.

Migraine Unilateral 4–72 hr Pulsating pain with Acute: NSAIDs, triptans,
nausea, photophobia, or dihydroergotamine.
phonophobia. May have Prophylaxis: lifestyle changes
“aura.” Due to irritation of (eg, sleep, exercise, diet),
CN V, meninges, or blood β-blockers, amitriptyline,
vessels (release of vasoactive topiramate, valproate,
neuropeptides [eg, substance botulinum toxin, anti-CGRP
P, calcitonin gene-related monoclonal antibodies.
peptide]). POUND–Pulsatile, One-day
duration, Unilateral, Nausea,
Disabling.
Tension Bilateral > 30 min Steady, “band-like” pain. No Acute: analgesics, NSAIDs,
(typically 4–6 photophobia or phonophobia. acetaminophen.
hr); constant No aura. Prophylaxis: TCAs (eg,
amitriptyline), behavioral
therapy.

Other causes of headache include subarachnoid hemorrhage (“worst headache of my life”), meningitis, hydrocephalus,
neoplasia, giant cell (temporal) arteritis.
a Compare with trigeminal neuralgia, which produces repetitive, unilateral, shooting/shock-like pain in the distribution of
CN V. Triggered by chewing, talking, touching certain parts of the face. Lasts (typically) for seconds to minutes, but episodes
often increase in intensity and frequency over time. First-line therapy: carbamazepine.

FAS1_2019_12-Neurol.indd 518 11/8/19 7:39 AM