The pattern of severe headaches in a clinic population of 250 indigenous Sierra Leonean Africans is studied. The sex ratio was 2.2 females to one male. The commonest cause of severe headaches was migraine, both common and classical, accounting for over 40% of cases. Next most common was tension headache. The prevalence of sinusitis of etiological importance was high at 15.6 per cent. Environmental and local cultural factors may contribute to such a high proportion. Hypertension, on the other hand, though a widespread medical problem accounted for only 4.4 percent of cases.

The prevalence of sickling positivity, though higher in the migraine groups, was not significantly higher than in the general population.

Four patients with severe headaches died mainly from tumors and hemorrhage giving a mortality of about 1.6%.

It appears as if the pattern of severe headaches in the Sierra Leonean African is basically similar to that of other racial groups.