Neurology

Recurrent moderate-to-severe, often unilateral, pulsating headache lasting 4-72 hours, worsened by activity and accompanied by nausea, photophobia, and phonophobia.

Tension headache is bilateral, pressing or tightening (band-like), mild-to-moderate, not aggravated by routine activity, and lacks nausea or significant photophobia/phonophobia.

Severe, strictly unilateral periorbital/temporal pain in attacks lasting 15-180 minutes, clustering over weeks, with ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis) and restlessness.

Thunderclap onset, new focal neuro deficit, new headache after age 50, immunosuppression/cancer, papilledema, positional or Valsalva-triggered headache, fever with neck stiffness, or progressive worsening pattern.

Triptans (e.g., sumatriptan) are first-line abortive therapy; NSAIDs or acetaminophen for milder attacks; add an antiemetic for nausea. Treat early in the attack.

Consider prophylaxis with frequent (≥4/month) or disabling migraines; options include beta-blockers (propranolol), topiramate, amitriptyline, valproate, and CGRP monoclonal antibodies.