The pineal gland is located in the posterior aspect of the medial superior of the dorsal thalamus. It is most developed in children at the age of 7-8 years and then gradually atrophies and degenerates, with a decrease in glandular cells and a proliferation of connective tissue. It is an active endocrine organ that secretes mainly melatonin. In addition, there are large amounts of 5-hydrocarbon tryptamine and norepinephrine in the pineal gland, which play an important role in controlling the biological Sunday rhythm. Calcification of the pineal gland is not uncommon in adults and is most often associated with insomnia. Some studies have shown that the main cause of insomnia in humans is the occurrence of disorders of pineal hormone in the brain. Insomnia in the elderly is the result of gradual calcification of the pineal gland, atrophy, and reduced secretion of pinealectin. About 75% of normal adults have pineal gland calcification on CT scan. Pineal calcification tends to cause insomnia. Usually, pineal calcification is a normal physiological phenomenon, but if the condition is severe, prompt treatment is required. 1. Blood pressure measurement, electrocardiogram and blood tests Do not forget to measure blood pressure regardless of the condition. Many patients with displaced pineal gland calcification are hypertensive patients who have not been treated systematically. Secondly, the contraindications of the potent drugs for migraine, such as treprostin, are hypertension, liver damage, previous history of cerebrovascular disease and myocardial infarction, and ischemic heart disease. It is important to know if there are any of these contraindications before using the drug. Previous myocardial infarction or suspected angina pectoris requires an electrocardiogram. In addition, blood tests are required for first-time patients. Vasculitis represented by temporal arteritis and cavernous sinusitis may have inflammatory manifestations such as leukocytosis in peripheral blood, increased sedimentation, and positive CRP. 2.Cerebral angiography (DSA) Although cerebral angiography is a more invasive test for pineal calcification displacement, it is the best test for vascular lesions such as aneurysm or venous sinus thrombosis that are difficult to detect with CT and MRI. Among the pineal calcific migrations that cannot be missed are headaches caused by intracranial entrapment aneurysms, which are more common in young people. Those with hemorrhage have a very dangerous prognosis when they add the pain of subarachnoid hemorrhage on top of the pain of damage to the vessel wall. Cerebral angiography can easily detect this lesion. EEG is necessary for the diagnosis of pineal calcific displacement EEG is necessary for the diagnosis of pineal calcific displacement. Patients with displaced pineal calcification can sometimes present with epileptic EEG abnormalities, especially in some pediatric headache patients who present with epileptic seizure waves and effective antiepileptic drugs. Most of these are simple partial seizures (autonomic seizures), a headache characterized by sudden onset, mostly accompanied by nausea, vomiting, and post-ictal sleepiness or drowsiness, similar to migraine attacks. Some cases have both characteristics, suggesting that there may be pathophysiological correlation between the two. 4. Cerebrospinal fluid examination For suspected calcified displacement of the pineal gland, it is necessary to examine the cerebrospinal fluid. A lumbar puncture can determine the level of cranial pressure, hemorrhage, yellowing and the presence of meningitis. In particular, cerebrospinal fluid examination is necessary to identify the pathogenic bacteria causing meningitis.