Evaluation of Headache

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Pattern Recognition

History

A systematic history is the single most important factor in establishing a headache diagnosis and determining the future work-up and treatment plan. A thorough history also helps focus the physical examination and prevent unnecessary investigation and imaging studies.

A systematic case history should include the following:


 Age at onset

 Presence or absence of aura and prodrome

 Frequency, intensity and duration of attack

 Time and mode of onset

 Quality, site, and radiation of pain

 Associated symptoms and abnormalities

 Family history of migraine

 Precipitating and relieving factors

 Effect of activity on pain

 Relationship with food/alcohol

 Response to any previous treatment

 Any recent change in weight or vision

 Association with recent trauma

 Any recent changes in sleep, exercise, or diet

 State of general health

 Change in work or lifestyle

 Change in method of birth control (women)

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