Headache often occurs in acute ischemic stroke. About 15–45% of patients with acute ischemic stroke report headache in close relation to the event. The onset of headache is more common in posterior circulation stroke. Headache is the leading symptom in subarachnoid hemorrhage. Acute severe headache with neurological deficit needs neuroimaging. AIM; Headache is a common symptom in acute stroke. Here we studied the headache in an acute cerebrovascular accident. METHODS; This study is done in the Department of Neurology in Coimbatore Medical college hospital from December 2018 to April 2019. INCLUSION CRITERIA; All patients with acute headache due to the cerebrovascular accident are included. EXCLUSION CRITERIA; Headache due to non–stroke causes were excluded. RESULTS; This study is done in 56 patients with acute cerebrovascular accident presented with headache. Mean age in males 50.25 years. Mean age in females 57 years. Ischemic stroke is 75%. Hemorrhagic stroke 25%. Ischemic stroke showed statistically significant frontal headache(p<0.001) in anterior circulation stroke and occipital headache in (p <0.001) posterior circulation stroke. Hemorrhagic stroke showed 50% frontal, 25% occipital,12.5% parietal and 12.5% diffuse headache according to the site of bleed. Common risk factors were HTN, diabetes and dyslipidemia. A thunderclap headache is common in sub Arachnoid bleed. Headache in cerebral venous thrombosis is diffuse dull aching or thunderclap headache according to the site of thrombosis