Hello, Thanks for posting this question in HCM Let me tell you the causes of headache are many and one has to find out the exact cause. Headache can be due to migraine, cluster headache, brain tumor, infection, vascular malformations and so on. I have noted all your problems You need to be re-evaluated in a hospital/teaching medical university with Multidisciplinary facility where neurologist/headache specialist / dentist/ interventional radiologist will jointly evaluate you. Their clinical evaluation will determine if you need a brain MRI scan (I am not sure if you have done to rule out any vascular malformation in the brain too). Some people may harbor vascular malformations in multiple sites of the brain. If it turns out to be migraine (which is a diagnosis of exclusion), you will benefit with the following approach 1. Acute attack: simple analgesics. Sumatriptan nasal spray. Avoid the precipitating factor. Avoid stress, coffee and lack of sleep. Do regular exercises and good sleep hygiene 2. During the chronic phase: You may take one of these medicines: Amitriptiline, propranolol, topiramate, valproate etc. The changes which are seen in the skull and spike are due to the presence of long standaing vascular malformaion. Hope this helps