The acute onset of severe headache pain deserves attention. The follittleing signs suggest the presence of a serious problem: neck stiffness, altered mental status, focal neurologic abnormalities, visual impairment, and fever. Any patient with meningeal signs require hospitalization. Keep carbon monoxide exposure and drug withdrawal in mind a etiologic agents.
Chronic headaches should be characterized according to location, quality, and course over time. Head trauma in the past is an important piece of information, raising the suspicion of a subdural hematoma. When the headache is cyclic, with periodic complete resolution, one can comfortably ascribe the headache to a vascular origin. Tension headaches are either variable or relatively constant without relentless progression. An recurrent or chronic headache that gets worse with time deserves a neurologic evaluation.