**Question:** A female aged 30 presents with episodic throbbing headache for past 4 years. It usually involves one half of the face and is associated with nausea and vomiting. There is no aura, most likely diagnosis is-

A. Migraine
B. Tension headache
C. Bacterial meningitis
D. Subarachnoid hemorrhage

**Correct Answer:** .

**Core Concept:**
Headaches are common symptoms in clinical practice and can be categorized into primary and secondary causes. Primary headaches include migraine, tension headache, and cluster headache. Secondary headaches result from an underlying medical condition and should be considered when the headache is severe, focal, and associated with specific symptoms.

**Why the Correct Answer is Right:**
In this case, the patient presents with episodic throbbing headache, usually involving one half of the face, and is associated with nausea and vomiting. Migraine (A) is the most suitable diagnosis among the given options. Migraine is a primary headache disorder characterized by unilateral, pulsating headache, often severe, and associated with nausea, vomiting, and photophobia. The headache typically occurs in association with specific triggers and is not typically associated with aura.

**Why Each Wrong Option is Incorrect:**

B. Tension headache (Option B) is a primary headache disorder characterized by a band-like, non-pulsating headache that is usually bilateral and not associated with nausea, vomiting, or photophobia.

C. Bacterial meningitis (Option C) is a secondary headache caused by inflammation of the meninges due to bacterial infection. This headache is typically generalized, severe, and accompanied by fever, lethargy, and neck stiffness.

D. Subarachnoid hemorrhage (Option D) is a secondary headache caused by bleeding in the subarachnoid space. This headache is typically severe, sudden, and accompanied by focal neurological deficits, confusion, and focal neurological signs.

**Clinical Pearl:**
In clinical practice, it is essential to consider both primary and secondary headache disorders when assessing a patient with a headache. While tension headache and migraine are common primary headaches, recognizing the specific symptoms and triggers can help distinguish between them. Bacterial meningitis and subarachnoid hemorrhage are secondary causes of headache and are typically associated with more severe symptoms and signs.