The localization of the initial pain of attack. A comparison between classic migraine and cervicogenic headache

Twenty-two patients with classic migraine and eleven patients with cervicogenic headaches were questioned about the localization of the initial and late pain during attack. Twenty of the classic migraine patients (91%) felt the initial pain in the forehead and temporal areas, whereas an ocassional, solitary primary involvement of the neck was found in one case (5%). As the attack evolved, there was a co-involvement of more areas. An initial involvement of the forehead and temporal area occurred in only 3 patients (27%) with cervicogenic headache, whereas 8 (73%) felt the initial pain in the neck. Also in the cervicogenic headache patients there was subsequent coinvolvement of more areas as the attack evolved. In the full-blown attack, the pain seemed very similar in the two patient groups. The localization of initial pain may be a useful feature in pattern recognition in headache diagnostics.