Mode of onset | • Sudden onset, maximal severity <15 minutes | • Subarachnoid haemorrhage |
| • Acute onset increasing in severity | • Meningitis, encephalitis, glaucoma |
| Subacute onset | • Temporal arteritis |
| | • Expanding intracranial pathology |
| | • Venous sinus thrombosis |
| | CO poisoning |
| | Hypertension |
| chronic | Tension headache |
Frequency and duration | Important to distinguish types of recurrent headache | Primary headache syndromes: |
migraine |
| | cluster headache |
| | tension headache |
| | trigeminal neuralgia |
Site and radiation | • Occipital radiating to neck | • Subarachnoid haemorrhage |
| Unilateral | Migraine, trigeminal neuralgia |
Previous headache history/change from usual pattern | • Worse headache ever | • Subarachnoid haemorrhage |
| Previous history, no change | Primary headache syndromes |
Time of onset | • Worse on waking | • Raised intracranial pressure |
Associated features | • Vomiting | • SAH, meningitis, glaucoma |
| • Neck stiffness/Photophobia | • SAH, meningitis |
| • Fever | • CNS or ENT infection |
| • Other neurological symptoms | • Intracerebral haemorrhage, stroke |
| • Proximal weakness/jaw claudication | • Temporal arteritis |
| Visual/olfactory aura | Migraine |
Aggravating/precipitating factors | • ↑ by head movement, coughing, straining | • Raised intracranial pressure |
| triggers eg. cheese, chocolate, menstruation | Migraine |
| Resolves with simple analgesia | Unlikely sinister cause |
Family history | • Subarachnoid haemorrhage | • Subarachnoid haemorrhage |
History of recent trauma | | • Subdural haemorrhage |
| | Post-concussion headache |
Drug history | • Warfarin | • Intracerebral haemorrhage |