Migraine does not usually begin explosively. Explosive-onset headaches should raise the concern or intracraneal hemorrhage or pheochromocytoma. Psychosomatic illness such as stress, worry, or anxiety can bring on a disorder of the body in the form of a headache. In contrast, tension headache does not connote emotional tension but rather tension of the scalp musculature whose prolonged contraction is the source of the head pain. The pain of migraine is classically unilateral but may be bilateral and diffuse.
Most children localize the center of pain as temporal, frontal, or retro-orbital.
The quality is described as throbbing, pounding, or hammering, occasionally synchronous with the beating of the heart.