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Unilateral pain radiating to the throat, ear, eye, nose, cheek or face is typical of the neuralgias. Facial pain extending beyond the territory of the trigeminal nerve and which may be bilateral or involve the tongue or mouth suggests a psychogenic cause. Pain radiating to the neck with tenderness of the neck muscles is typical of tension headache and cervicogenic headache.

TABLE 6.3 Relationship between the cause and site of headache




Bilateral, generalised or nuchal


Tension headache

Bilateral, generalised or nuchal


Unilateral: different sides on separate occasions

Cluster headache

Unilateral: eye, nose, cheek

Cranial arteritis

Unilateral with scalp tenderness

Trigeminal neuralgia

Unilateral: maxillary or mandibular branches of

the trigeminal nerve

Post-herpetlc neuralgia

Unilateral: ophthalmic branch of the trigeminal


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