II. Symptoms

  1. Characteristics
    1. Pressing, tightening Headache
  2. Region
    1. Bilateral involvement
  3. Timing
    1. Constant and unremitting in the first 3 days and then persists
      1. Contrast with Migraine Headache or Tension Headache that may be become constant over a longer period of time
    2. Duration longer than 3 days from onset
    3. Occurs daily for >3 months
  4. Provocative factors
    1. Not worse with exertion (contrast with Exertional Headache)
    2. No associated autonomic symptoms (contrast with Cluster Headache and other trigeminal autonomic Cephalgias)

III. Management

  1. Typically refractory to standard Headache Management
  2. Consider Migraine Prophylaxis medications

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