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The general approach to headache as a cardinal symptom are covered elsewhere (Chap. 13); here, disorders in which headache and associated features occur in the absence of any exogenous cause are discussed. The most common are migraine, tension-type headache (TTH), and the trigeminal autonomic cephalalgias (TACs), notably cluster headache; the complete list is summarized in Table 422-1.

TABLE 422-1Primary Headache Disorders, Modified from International Classification of Headache Disorders-III-Beta (Headache Classification Committee of the International Headache Society, 2018)


Migraine, the second most common cause of headache, and the most common headache-related, and indeed neurologic, cause of disability in the world, afflicts ~15% of women and 6% of men over a 1-year period. It is usually an episodic headache associated with certain features such as sensitivity to light, sound, or movement; nausea and vomiting often accompany the headache. A useful description of migraine is a recurring syndrome of headache associated with other symptoms of neurologic dysfunction in varying admixtures (Table 422-2). A migraine attack has three phases: premonitory (prodrome), headache phase, and postdrome; each has distinct and sometimes disabling symptoms. About 20–25% of migraine patients have a fourth, aura, phase. Migraine can often be recognized by its activators, referred to as triggers.

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