Headache

 

History:

Severity, chronologic pattern and associated symptoms

• Location? Unilateral or bilateral? Positional changes?
• Severe with sudden onset, like a thunderclap? Intensifying over minutes or hours?
• Steady or throbbing?
• Continuous or intermittent? Episodic? Chronic or recurring?
• Is the headache “typical” or is there something different? Changes in pattern?
• Is there an aura? Changes in vision? Weakness or numbness?
• Nausea and vomiting?
• Overuse of analgesics, ergotamines or triptans?
• Family history?

Differential Diagnosis:

• Secondary – With an identified underlying disease
  • Meningitis
  • Subarachnoid hemorrhage
  • Mass lesion – New, persisting and progressively severe headaches
• Primary – Without an identified underlying disease
  • Tension – Temporal areas
  • Migraine – Unilateral
  • Cluster – Retro-orbital
  • Chronic

References:

Bickley, Lynn S., Bates’ Guide to Physical Examination and History Taking. 12th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, p. 216.