###Human: What is causing frequent headaches in the middle of skull? ###Assistant: Hi. Your headache most likely is migraine since it has been going on for the last 12 years. Another less likely possibility is occipital neuralgia. One thing that is not clear from your description is whether the pain is localized to one side or occurs on either side. Nevertheless, I would recommend the following: 1. MRI of the brain to rule out structural abnormalities that could be causing the headache. 2. Start on tablet Topiramate 25 mg twice a day and build up to 50 mg twice a day. 3. Maintain a headache diary- note the time, duration and character of pain in a diary each time you have pain. 4. Consider tablet Pregabalin 75 mg twice a day if Topiramate is not effective. Migraine or occipital neuralgia. Migraine or occipital neuralgia.