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Headache History
Aka: Headache History, Headache Evaluation
- See Also
- Headache
- Headache Red Flag
- Headache Causes
- Headache Examination
- Headache Diagnostic Testing
- Neuroimaging in Headache
- Approach
- Consider Headache diary
- Should include Headache date, duration, symptoms, triggers, treatment and outcome
- https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/diagnosis/headache-diary.html
- Key goals for Headache History
- Identify different Headache types (typical Headaches as well as new or changed Headache patterns)
- Many patients have both Tension Headaches and Migraine Headaches
- Identify episodic Headache to chronic Headache patterns
- Identify Organic Headaches (see Headache Red Flags)
- Identify Medication Overuse Headache
- History: Headache Timing
- New, Chronic or Recurrent Headache
- Acute Headache
- Acute Generalized Headache
- Acute Localized Headache
- Acute Recurrent Headache
- Chronic Headache
- Chronic Progressive Headache
- Chronic Non-Progressive Headache
- Duration of chronic Recurrent Headaches
- Headache >4 hours
- Migraine Headache: 6 to 36 hours typical
- Tension Headache: Constant daily Headache
- Headache <4 hours
- Autonomic features
- Cluster Headache: 30 to 90 minutes
- No autonomic features
- Trigeminal Neuralgia
- Headache that awakens patient overnight
- Hypoxia (e.g. Sleep Apnea, COPD)
- Carbon Monoxide Poisoning
- Bruxism
- Drug Withdrawal (includes Caffeine)
- Migraine Headaches
- Cluster Headache
- Narrow Angle Glaucoma
- CNS Mass
- Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
- History: Organic Headache Assessment
- See Headache Red Flag
- See Organic Headache
- See Acute Generalized Headache
- First or worst Headache? (Headache Red Flag)
- Intracranial Hemorrhage
- CNS Infection (Meningitis, Encephalitis, Brain Abscess)
- Headache onset
- Gradual onset suggests benign cause
- Severe, sudden onset (Thunderclap Headache) is a Headache Red Flag
- Age of Headache onset
- Under age 30 years is associated with lower risk Headaches
- Migraine Headaches rarely have onset after age 40 years
- History: Headache localization and radiation
- Bilateral or Generalized
- See Acute Generalized Headache
- See Chronic Daily Headache (Tension Headache)
- Localized (more significant than generalized)
- See Acute Localized Headache
- Common primary unilateral Headaches
- Cluster Headache
- Migraine Headache
- Trigeminal Neuralgia
- Temporal forehead
- Temporal Arteritis
- Eye strain (especially with Astigmatism)
- Migraine Headache
- Trigeminal Nerve distribution
- Trigeminal Neuralgia
- Jaw pain
- Temporomandibular Joint Disorder
- Occipital pain
- Hypertension
- Tension Headache (usually Generalized Headache)
- Increased Intracranial Pressure
- Cervical Radiculopathy
- Occipital Neuralgia
- Eye Pain
- Acute Glaucoma
- Temporal Arteritis
- Acute Sinusitis
- Eye strain
- Occipital neuralgia due to Cervical Radiculopathy
- Cluster Headache
- Migraine Headache
- Lower face
- Trigeminal Neuralgia
- History: Headache characteristics
- Pounding Headache
- Carbon Monoxide Poisoning
- Nitroglycerin or other Vasodilator medications
- Migraine Headache
- Lancinating Headache (sharp, stabbing pain)
- Trigeminal Neuralgia
- Occipital neuralgia due to Cervical Radiculopathy
- Ice pick Headache (Migraine variant)
- Cluster Headache
- Throbbing Headache
- Acute Sinusitis
- Migraine Headache
- Pressure Headache
- Tension Headache
- History: Demographics
- Home environment
- More than one family member with acute Headache
- Carbon Monoxide Poisoning (until proven otherwise)
- Gender Predominance
- Male
- Cluster Headache
- Female
- Hormonal Headache (e.g. Menstrual Migraine)
- Basilar Migraine Headache (female adolescents)
- Age at Headache onset
- Young Child
- Hemiplegic Migraine Headache
- Ophthalmoplegic Migraine Headache
- Older Child, Adolescent and Young adult
- Migraine Headache
- Tension Headache
- Temporomandibular Joint Disorder
- Basilar Migraine Headache (female adolescents)
- Paroxysmal Hemicrania
- Similar to Cluster Headache without Lacrimation
- Cluster Headache (rare in children)
- Occipital Neuralgia
- Adult of middle age and older
- See Headaches due to Medication
- Temporal Arteritis
- Hypertension
- Intracranial Mass
- Cerebrovascular ischemia
- Cervical Radiculopathy (Cervical Spondylosis)
- Chronic Obstructive Pulmonary Disease
- Hypnic Headache
- History: Associated Symptoms or Signs
- Concurrent mental health concerns (e.g. Anxiety)
- Tension Headache
- Stress provokes Headache
- Tension Headache
- Migraine Headache
- Aura or prodrome
- Migraine Headache
- Seizure Disorder
- Lacrimation, Rhinorrhea and facial Flushing
- Cluster Headache
- Myalgias or Arthralgias
- Temporal Arteritis (Polymyalgia Rheumatica)
- Exertional Headache
- Organic Headache (Intracranial Mass)
- Benign Exertional Headache
- Recent Head Trauma
- Intracranial Hemorrhage (e.g. Subdural Hematoma)
- Post-Concussion Syndrome
- Vision related symptoms
- Temporal Arteritis
- Glaucoma
- Migraine Headache (scotomata, photophobia)
- Vomiting
- Migraine Headache (Nausea)
- Increased Intracranial Pressure (no Nausea)
- Facial tic
- Trigeminal Neuralgia
- History: Modifying Factors
- Palliative Factors
- Headache relieved when removed from environment
- Carbon Monoxide Poisoning
- Sleep
- Migraine Headache
- Oxygen at 100% FIO2
- Cluster Headache
- Provocative Factors
- See Migraine Headache Triggers
- Current medications
- Analgesics, Ergotamines or Triptans on more than 10-15 days per month
- See Rebound Headache
- Other medication associated Headaches
- See Increased Intracranial Pressure Causes
- See Medication Causes of Headache
- References
- Cutrer in Goldman (2000) Cecil Medicine, p. 2066
- Duman in Friedman (1991) Medical Diagnosis, p. 392-3
- Henry in Marx (2002) Rosen's Emergency Medicine, p. 152
- Pruitt in Goroll (2000) Primary Care Medicine, p. 931-9