<prompt> A 64-year-old lady Kamla complains of severe unilateral headache on the right side and blindness for 2 days. On examination, there is a thick cord-like structure on the lateral side of the head. The ESR is 80 mm hr. in the first hour. The most likely diagnosis is :Temporal arteritisA migraineCluster headacheSinusitis  <response>: Ans. is a i.e.,. Temporal Arteritis The symptom and the laboratory examination of the patients almost confirm the diagnosis of temporal arteritis.This question has been asked too frequently in various PGME examination you are required to be well versed with the differential diagnosis of a headache.Lets see the diagnostic features of various headaches.A migraineAge - Females after pubertySex - Females malePresentationLateralisedusually frontotemporalPain preceded by AuraBuilds up graduallyMay lasts for several hoursUsually throbbing but may be dullOnset is after awakening quietened by Sleep. Associated symptoms includeNausea, vomiting, Diarrhoea, photophobia Visual disturbanceParesthesia with tingling and numbnessOther focal neurological symptoms such as clumsiness weakness .Cluster HeadacheMen in 20 - 50MaleF 7 to 8 timesLateralisedPeriorbitalPainperiodic attacks 1-2daysBegins without warning. Reach crescendo within 5 min last for 45 minutesExcruciating deep, explosive but only rarely pulsatile.Commonly awakens the patients from sleep.Associated SymptomsHomolateral lacrimationReddening of eyeNasal stuffinessPtosisNauseaTrigeminal Neuralgia 40 YearsOccurs along the distribution of Maxillary nerveElectric in characterEpisodic each episode lasts 2-4 min.The typical course is relapsing-remitting over several years.Temporal ArteritisMedian age 75 yrsFemale Account for 65 casesUnilateral or Bilateral located temporarily in 50 patientsUsually appear graduallyOccasionally it is explosive.Dull and boring in character,Seldom throbbing.Scalp tendernessPatients also complains of pain in jawHeadache is usually worse at night.Associated symptomsHeadache, fever, weight lossJaw claudicationPolymyalgia RheumaticaESR IncreaseAnemiaBlindness dt ophthalmic artery involvement.A tension HeadacheAt all agesFemalesBilateral Frontal area Builds up slowlyFluctuates in severityPersists continuously for many days.A headache may be episodic or chronic.A tight band like discomfortAssociated symptomsNot prominentSometimes post neck muscles are tightMay be associated with anxiety depression. 