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 |