ABSTRACT
The most common patient seen in clinical practice is the one with more than one type of headache. These patients have frequently seen many other clinicians and still complain of headaches, most typically daily. For the patient with combination headache, diagnosis is everything. A problem with the myth of unilateral headache being migraine is that an acute, unilateral muscle spasm or cervical strain/sprain may bring on an acute, one-sided headache with throbbing pain. It may be associated with photophobia and even nausea, possibly vomiting. The pain description of cluster headache, as well as chronic paroxysmal hemicrania (CPH), does not sound like anything else, although clinicians have to rule out neuropathy before they come to the diagnosis of CPH. In patients with a post-traumatic headache, clinicians need to be aware enough to at least consider the possibility of a mild traumatic brain injury or post-concussion syndrome.
