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Recent evidence has demonstrated that neurogenic vascular headaches are a combinationof neurological primary events and secondary vasomotor changes. The neurological events involve the hypothalmus and sensory cortex with sympathetic hypofuncti on and noradrenergic abnormalities. A platelet theory has been proposed but has not really been confirmed as a legitim ate cause of the neurogenic vascular head aches. Food and chemicals in foods can act as a precipitating factor in the food-sen sitive neurogenic vascular headache patient. In these patients evidence is now being demonstrated to confirm this, but larger patient studies are needed. The food-sensitive migraine patient and cluster headache patient must give a good history and food diary to go along with active challenges and provocative testing in order to determine the causative foods. Any concomitant allergies of inhalants or environmentals must also be treated. The treatment modalities of elimination and rotation diets or provocation neutralizationmay successfully control the headaches without the need for continuous medications.

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