Headache is one of the common presenting complaints in a physcians office. It is important to identify which headaches are benign, needing no intervention and which requires action. Following questions needs to be asked in history:
1. Does the patient have >1 type of headache?
2. Time:When did the headache start? New or recently changed headache calls for especially careful assessment. How often do they happen? Do they have any patteren( e.g constant,episodic,daily). How long do they last? Why is the patient coming to the doctor now?
3. Character: Nature and quality, site and spread of the pain. Associated symptoms e.g nausea/vomiting, visual disturbance, photophobia, neurological symptoms.
4. Cause: Ask about predisposing and /or trigger factors; aggrravating snd /or relieving factors; family history of similar headaches.
5. Response:Details of medication used (type, dose, frequency, timing). What does the pateint do? e.g can the patient continue work?
6. Health between attacks: Do the headaches go completely or does the patient feel unwell between attacks?
7. Anxieties and concerens of the patient
In acute seveer headache, examine for purpuric skin rash. In all cases check BP, brief neurological examination including fundi, visual acuity and gait, palpation of temporal regions/ sinuses for tenderness and examination of neck. In young children measure head circumference and plot on centile chart.
Red Flags To Take Immediate Action
- New unexpected headache Continue reading “Approach To Patients Presenting With Headache”