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More than 54 Million people annually suffer from headaches. Migraine and TTH are the most prevalent primary headache disorders. Globally >10% of the population is estimated to suffer from migraine which ranges from 9.7% in north america to 16.4% in south america. Migraine is in the second place among the leading causes of disability through 1990 up to 2016 showing the ongoing burden of the disease, about 1 billion patients worldwide. Migraine is associated with substantial personal, family and economic burden, which worsens with increased frequency of attacks.

Prevalence of migraine in different Arab countries will be discussed.

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Headache in pregnancy is not uncommon. One of the mqin causes of headache in pregnancy is migraine. Migraine can present for the first time in pregnancy. The majority of patients suffering from migraine do improve during pregnancy especially in the second and third trimester. It's very important to emphasize for the patients the role of non pharmacological managements during this special time of her life.
Treating migraine in pregnancy is challenging in terms of prevention and abortive therapy. Triptans and non steroidal drugs are the main fear for the patients and their treating physicians.

in this presentation we will discuss the headache in pregnancy and how to approach and manage patient with migraine at this unique time in their life.

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Headache is a common accompanying symptom of cerebrovascular diseases, and may represent the only symptom at onset or predominates over the other neurological features. Indeed, the third edition of the International Classification of Headache Disorders (ICHD-3) dedicates an entire chapter to headache attributed to cranial or cervical vascular disorder. It includes headaches attributed to non traumatic intracranial hemorrhage, arterial dissection, acute ischemic stroke, cerebral venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, arteritis and chronic intracranial vasculopathy such as CADASIL or MELAS.

Unfortunately, headache associated with cerebrovascular diseases lacks clear-cut characteristics. The descriptions may range from a thunderclap onset to a phenotype similar to tension type headache. However, many of these headaches can be present with peculiar characteristics as in the case of thunderclap headache following subarachnoid hemorrhage or cerebral reversible vasoconstriction syndrome. In cervicocerebral artery dissection pain is most commonly ipsilateral to the dissected vessel, mainly perceived in the temporal area in carotid artery dissection and in the occipital area in vertebral artery dissection. Otherwise, pain can mimic primary headaches, mostly migraine, tension-type headache, or cluster headache, as described in the case of vascular artery dissection or symptomatic arteriovenous malformations. Headache may lack specific features as seen in cerebral venous thrombosis.

Therefore, it is essential to be aware of the relationship between headache and cerebrovascular diseases, in order to can timely recognise causes and intervene as soon as possible to avoid permanent sequelae that result in disability.