Symptoms that are specifically associated with each headache type are important diagnostic aids. Visual symptoms are common features of migraine and may include scintillating phenomena, teichopsia, hemianopsia field defect, scotoma, and photophobia. Complaints of rapid and progressive impairment of vision may occur in association with papilledema caused by a mass or increased intracranial pressure of some other cause. Persistent visual field defects, a serious complication in patients with temporal arteritis, may be heralded by local temporal pain on the affected side. Another visual symptom of potentially serious significance is diplopia, particularly when it is persistent.
Vomiting is a potentially serious symptom.
On the other hand, projectile vomiting associated with headache may indicate increased intracranial pressure, or it can be a symptom of a systemic disorder associated with headache, such as fever, toxic reactions, allergic reactions, and sunstroke. Headache with persistent symptoms of paresis, paralysis, ataxia, or sensory disturbance may indicate structural lesions and should always be regarded as serious. On the other hand, episodic recurrence of such symptoms may indicate that the associated headache is a subclassification of migraine. Direct questions should be asked about any soreness, tenderness, and stiffness of the head and neck structures. The vascular headache of temporal arteritis may be associated with soreness and tenderness over one temple.