Table 3

 Important factors in the history of a headache

Factors to considerSignificancePossible 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
chronicTension headache
Frequency and durationImportant to distinguish types of recurrent headachePrimary headache syndromes:
 cluster headache
 tension headache
 trigeminal neuralgia
Site and radiation• Occipital radiating to neck• Subarachnoid haemorrhage
UnilateralMigraine, trigeminal neuralgia
Previous headache history/change from usual pattern• Worse headache ever• Subarachnoid haemorrhage
Previous history, no changePrimary 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 auraMigraine
Aggravating/precipitating factors• ↑ by head movement, coughing, straining• Raised intracranial pressure
triggers eg. cheese, chocolate, menstruationMigraine
Resolves with simple analgesiaUnlikely sinister cause
Family history• Subarachnoid haemorrhage• Subarachnoid haemorrhage
History of recent trauma• Subdural haemorrhage
Post-concussion headache
Drug history• Warfarin• Intracerebral haemorrhage