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Tension-type headache and migraine are the most common types of primary headaches. Apart from these well known diseases, the group of primary headaches includes other relatively rare headache disorders. Some of these seldom syndromes have been described for the first time within the last twenty years and have been newly included in the revised IHS classification from 2004. Their typical symptomatic is less known, but offers an excellent opportunity to diagnose these syndromes. The importance of recognising these disorders is underlined by the fact, that rare primary headaches response often complete and rapid to a specific treatment. This review summarizes the current knowledge on the clinical presentation and treatment of cluster headache, paroxysmal hemicrania, SUNCT syndrome, hemicrania continua and hypnic headache.

Although the elderly generally suffer less often from headache, symptomatic headache and concomitant diseases are more frequent. For the diagnostic work-up of newly occurring headaches in old age, imaging examinations of the head (CT or MRI), together with laboratory investigations are necessary. The treatment of symptomatic headache is oriented to the underlying disease, and should be applied promptly, with the aim of preventing serious complications. When considering the management strategy, account must be taken of possible changes in pharmacokinetics, pharmacodynamics and the therapeutic response in the elderly. Numerous medications often cause headache or other side effects in patients of advanced age. Most antiheadache drugs have not been adequately been investigated in the group of over 65-year-olds. This means that drug treatment for headache is often applied in accordance with the principle: start low, go slow.

For the neurological differential diagnosis of facial pain, symptomatic pain must be differentiated from the so-called primary pain syndromes. Trigeminal neuralgia is usually readily diagnosed on the basis of the typical history. The treatment of choice is carbamazepine. If this fails, invasive options are available. Atypical facial pain should be diagnosed only when all known primary and secondary pain syndromes have been excluded. Treatment is difficult and comprises the administration of tricyclic antidepressants. Cluster headache and chronic paroxysmal hemicrania each has an unmistakable temporal course. Although the etiology remains unknown, specific therapeutic options are available. The Tolosa-Hunt syndrome is presumably caused by a granuloma in the cavernous sinus, and treatment is effected with corticosteroids. Painful craniomandibular dysfunction (CMD) is often misinterpreted as atypical facial pain.

The EEG examination of 45 patients with vascular headache and 44 patients with tension headache showed abnormal EEG's in 71% of the cases with migraine and 35% of the cases with tension headache. The examination of morphology and topography of alpha-rhythm and driving-effect during photic stimulation showed statistically significant differences between both groups. Applying specific characteristics in the EEG it is possible to differentiate both types of headache.

59 patients with cluster headache are discussed. Treatment can be divided into treatment of the acute attack, and prophylactic treatment. The acute attack can be interrupted in most cases by ergotamine, either sublingually or in the form of suppositories. A number of patients respond to the inhalation of pure oxygen. Most patients with the episodic type of cluster headache do well on prophylactic treatment with methysergide. If they prove refractory to this drug, treatment with lithium salts can be instituted. Most patients with the chronic type of cluster headache respond favourably to lithium therapy.

In 1942 a curve of skin conductibility to direct current was described in Prague. It is a slow or steep rising of intensity in the few seconds following the introduction of the 12 V current to the hand from the dorsum to the palm. This method has been called dermatophoria. This curve is characteristical for a given individual and it is different in paretic (central and peripheral) limbs, generally more flat. In children the curves are steeper. However, abnormally steep there are in 57% of juvenile vasomotor headaches. Dermatophoria is therefore promising to be an objective method in diagnosis of children's headache.

Erythroprosopalgia is characterized by severe unilaterally and periodically occurring attacks of headache. During these fits of pain there is an increase in blood flow in the homolateral eye, conjunctival injection and epiphora. Males aged between twenty and forty are most frequently affected. The clinical picture, therapy and differential diagnosis of this disease are discussed.