An approach to the headache history

An approach to the headache history

Table 1.1 An approach to the headache history

1. How many different headache types does the patient experience?

Separate histories are necessary for each. It is reasonable to concentrate on the most bothersome to the patient but others should always attract some

enquiry in case they are clinically important.

2. Time questions              a) Why consulting now?

                                        b) How recent in onset?

                                       c) How frequent and what temporal pattern (especially  distinguishing between episodic and daily or unremitting)?

                                        d) How long lasting?

3. Character questions             a) Intensity of pain?

                                              b) Nature and quality of pain?

                                              c) Site and spread of pain?

                                              d) Associated symptoms?

4. Cause questions                  a) Predisposing and/or trigger factors?

                                              b) Aggravating and/or relieving factors?

                                              c) Family history of similar headache?

5. Response to headache questions

                                               a) What does the patient do during the headache?

                                               b) How much is activity (function) limited or prevented?

                                               c) What medication has been and is used, and in what manner?

6. State of health between attacks

                                               a) Completely well, or residual or persisting symptoms?

                                               b) Concerns, anxieties, fears about recurrent attacks and/or their cause?