Headache is a frequent symptom in acute stroke, but the underlying mechanisms are not completely understood. We prospectively evaluated the headache features in patients with a first-ever acute stroke, either intracerebral haemorrhage (ICH) or ischemic stroke, and the association with stroke type, location, and other clinical variables. We analysed the characteristics of headache symptoms at stroke onset and the association between headache at stroke onset and several clinical variables in 196 patients admitted for a first-ever stroke in a tertiary care centre. We recorded the clinical onset and characteristics of the pain by stroke subtype. One hundred ninety-six consecutive patients suffering from a first-ever stroke were enrolled in the study. Seventy three (37.2%) patients reported headache at stroke onset. Headache was more commonly associated with ICH (51.4% (38/74)) than with ischemic stroke (28.7% (35/122)); OR = 2.62; 95% CI: 1.44-4.78. Headache was more frequent in posterior circulation stroke (61.91%; 15/25) than in anterior circulation stroke (30.1%; 25/83); OR = 3.485; 95% CI: 1.37-9.8. Large vessel stroke presented more frequently with headache than small vessel stroke (42.3% versus 16.0%), but it was not significant. It was also associated with younger age (<40 y); OR: 5.2 (1.61-17.2). According to clinical subtypes of headache, the dull ache was predominant, followed by throbbing and pulsatile ache. In conclusion Headache was a highly prevalent symptom in patients with acute stroke, haemorrhagic and ischemic as well. However the data from our cohort are not appropriate to establish either diagnostic or prognostic implications.