Acute and increasing headaches after traumatism may be a signal for important complications, namely: subarachnoid hemorrhage, infections from the sinus, subdural hematoma. In chronic posttraumatic headaches we do not see one single clear cut entity of "posttraumatism". The trauma acts mainly (pathophysiologically) via vasolability and via cervical spine. The important role of cervical spine for posttraumatic headaches is greatly underestimated, especially if the cranial trauma is looked at isolated, just by valuing X-rays and duration of unconsciousness. If we look at traumatism as a triggering respectively modifying factor it makes clear that we can not postulate an everlasting causation of headache by traumatism, but have to see posttraumatic headache in a fluent transition from trauma-etiology to a constitionally caused personality-etiology. Difficulties arise in giving a clear cut limit between the two causations. A time span of about two years is a ruff measure. Our multidimensional concept of headache etiology demands a clear analysis of the different factors. On the basis of this we can build up a polypragmatic way of therapy that acts as specific and complex as possible. This creates higher efficacy.