Prof. Shahzad Shams presently works as Head and Professor of Neurosurgery Department at Lahore General Hospital, LGH, Lahore.




The immediate goal of the history and examination of the patient with headache is to determine if the headache potentially represents an urgent or life threatening process or is a symptom of any other structural brain, meningeal or systemic process(and if not ,to determine by history which primary headache disorder is likely).

Pathophysiology of headache

Headache scan be broadly classified as secondary or primary.

·         Secondary headaches or due to a structural brain lesion (e.g tumor), increased intracranial pressure (e.g.tumor are hydrocephalus),a meningeal process (e.g meningitis  or  surbrachoniod hemorrhage),or systemic illness (e.g., temporal arteritis). These processes produce headache due to irritation of pain-sensitive intracranial (e.g. meninges) or extracranial (e.g., scalp) structures.

·         Primary headaches are not due to a structural brain, meningeal, or systemic process .Common primary headaches include migraine, tension and cluster headache. 

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