A hemicranial localization of the pain may suggest migraine. A pulsatile retroorbital pain may indicate an expanding aneurysm around the circle of Willis, arterial dissection, cluster headache, or inflammatory lesions of the orbital structures. Chronic pain experienced over the vertex or in a hatband distribution may suggest muscle contraction headache. For example, although headache severity is a subjective response, information on increasing or decreasing severity is very valuable. A throbbing pain that is not timed with the pulse is less specific.
Steady pain is less likely to be vascular in origin but can be if it is localized.
Steady pain of increasing severity over weeks, if generalized, may indicate increasing intracranial pressure. Another characteristic feature of intracranial pressure is the expanding nature of headache enhanced by activities such as bending, stooping, coughing, defecation, and sexual intercourse. 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.