Important factors in the history of a headache
Factors to consider | Significance | Possible diagnosis |
---|---|---|
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 |