II. Approach

  1. Consider Headache diary in chronic Headaches
    1. Should include Headache date, duration, symptoms, triggers, treatment and outcome
    2. https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/diagnosis/headache-diary.html
  2. Key goals for Headache History
    1. Identify different Headache types (typical Headaches as well as new or changed Headache patterns)
      1. Many patients have both Tension Headaches and Migraine Headaches
    2. Identify episodic Headache and chronic Headache patterns
    3. Identify Organic Headaches (see Headache Red Flags)
    4. Identify Medication Overuse Headache

IV. History: Organic Headache Assessment

  1. See Headache Red Flag
  2. See Organic Headache
  3. See Acute Generalized Headache
  4. First or worst Headache? (Headache Red Flag)
    1. Intracranial Hemorrhage (e.g. Subarachnoid Hemorrhage)
    2. CNS Infection (e.g. Meningitis, Encephalitis, Brain Abscess)
  5. Headache onset
    1. Gradual onset suggests benign cause
    2. Severe, sudden onset (Thunderclap Headache) is a Headache Red Flag (e.g. Subarachnoid Hemorrhage)
  6. Age of Headache onset
    1. Under age 30 years is associated with lower risk Headaches
    2. Migraine Headaches rarely have onset after age 40 years

VI. History: Headache Characteristics

  1. Pounding Headache
    1. Carbon Monoxide Poisoning
    2. Nitroglycerin or other Vasodilator medications
    3. Migraine Headache
  2. Lancinating Headache (sharp, stabbing pain)
    1. Trigeminal Neuralgia
    2. Occipital neuralgia due to Cervical Radiculopathy
    3. Ice pick Headache (Migraine variant)
    4. Cluster Headache
  3. Throbbing or Pulsatile Headache
    1. Acute Sinusitis
    2. Migraine Headache
  4. Pressure Headache
    1. Tension Headache

VII. History: Demographics

  1. Home environment
    1. More than one family member with acute Headache
      1. Carbon Monoxide Poisoning (until proven otherwise)
  2. Gender Predominance
    1. Male
      1. Cluster Headache
    2. Female
      1. Hormonal Headache (e.g. Menstrual Migraine)
      2. Basilar Migraine Headache (female adolescents)
  3. Age at Headache onset
    1. Young Child
      1. Hemiplegic Migraine Headache
      2. Ophthalmoplegic Migraine Headache
    2. Older Child, Adolescent and Young adult
      1. Migraine Headache
      2. Tension Headache
      3. Temporomandibular Joint Disorder
      4. Basilar Migraine Headache (female adolescents)
      5. Paroxysmal Hemicrania
        1. Similar to Cluster Headache without Lacrimation
      6. Cluster Headache (rare in children)
      7. Occipital Neuralgia
    3. Adult of middle age and older
      1. See Headaches due to Medication
      2. Temporal Arteritis
      3. Hypertension
      4. Intracranial Mass
      5. Cerebrovascular ischemia
      6. Cervical Radiculopathy (Cervical Spondylosis)
      7. Chronic Obstructive Pulmonary Disease
      8. Hypnic Headache

IX. History: Modifying Factors

  1. Palliative Factors
    1. Headache relieved when removed from environment
      1. Carbon Monoxide Poisoning
    2. Sleep
      1. Migraine Headache
    3. Oxygen at 100% FIO2
      1. Cluster Headache
  2. Provocative Factors
    1. See Migraine Headache Triggers
    2. Exertion or Sex (red flag for Organic Headache)
      1. See Exertional Headache
      2. Migraine Headaches may also be exacerbated by activity
    3. Menses
      1. Menstrual Migraine
    4. Current medications
      1. Analgesics, Ergotamines or Triptans on more than 10-15 days per month
        1. See Rebound Headache
      2. Other medication associated Headaches
        1. See Increased Intracranial Pressure Causes
        2. See Medication Causes of Headache

X. References

  1. Cutrer in Goldman (2000) Cecil Medicine, p. 2066
  2. Duman in Friedman (1991) Medical Diagnosis, p. 392-3
  3. Henry in Marx (2002) Rosen's Emergency Medicine, p. 152
  4. Pruitt in Goroll (2000) Primary Care Medicine, p. 931-9
  5. Viera (2022) Am Fam Physician 106(3): 260-8 [PubMed]

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Ontology: History of headache (C1960629)

Concepts Finding (T033)
SnomedCT 425978000
English History of headache (situation), History of headache
Spanish antecedente de cefalea, antecedente de cefalea (situaciĆ³n)