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Classifying headaches as primary (migraine, tension-type or cluster) or secondary can facilitate evaluation and management A detailed headache history helps to distinguish among the primary headache disorders. "Red flags" for secondary disorders include sudden onset of headache, onset of headache after 50 years of age, increased frequency or severity of headache, new onset of headache with an underlying medical condition, headache with concomitant systemic illness, focal neurologic signs or symptoms, papilledema and headache subsequent to head trauma. A thorough neurologic examination should be performed, with abnormal findings warranting neuroimaging to rule out intracranial pathology. The preferred imaging modality to rule out hemorrhage is noncontrast computed tomographic (CT) scanning followed by lumbar puncture if the CT scan is normal. Magnetic resonance imaging (MRI) is more expensive than CT scanning and less widely available; however, MRI reveals more detail and is necessary for imaging the posterior fossa. Cerebrospinal fluid (CSF) analysis can help to confirm or rule out hemorrhage, infection, tumor and disorders related to CSF hypertension or hypotension. Referral is appropriate for patients with headaches that are difficult to diagnose, or that worsen or fail to respond to management

Cluster headaches are episodes of excruciating unilateral facial pain, typically occurring in young men. Ipsilateral autonomic symptoms of nasal congestion, rhinorrhea, conjunctival injection and lacrimation are commonly present. Characteristic facial features may be found. Migraine and trigeminal neuralgia are two important considerations in the differential diagnosis. Prednisone and lithium are effective prophylactic medications for episodic and chronic forms of cluster headaches. Treatment with oxygen or ergotamines may be useful in aborting attacks.

Although classification can be difficult, determining the type of headache, such as tension, migraine or cluster, aids in the formulation of a therapeutic approach. Treatment involves regulation rather than cure. Acute and prophylactic pharmacotherapy and control of stress through behavior modification, relaxation training and biofeedback are methods of management.