The majority of patients with headache have a completely normal physical and neurologic examination. If a complete and careful history does not point to an organic etiology, further examination is warranted in the following areas:
Potential triggers may start an attack or worsen a preexisting headache. The role of most of these headache triggers has been well established in terms of migraine but remains less clear for other headache types. (Table 2).
Patients with any of the danger signs (see above) need urgent brain imaging.
Indications for less urgent brain imaging include the following:
A head CT scan (without and with contrast) is sufficient in most patients when neuroimaging is deemed necessary .
An MRI along with MRA are indicated when posterior fossa or vascular lesions are suspected.
Alcohol Let down periods
Chocolate Times of intense activity
Aged cheese Loss or change (death, separation, divorce, job Monosodium glutamate (MSG) change)
Aspartame (Nutrasweet) Moving
Hormones Changes of environment or habits
Ovulation Travel (crossing time zones)
Hormone replacement (Progesterone) Seasons
Sensory Stimuli Schedule changes
Strong light Sleeping patterns
Flickering lights Dieting
Odors Skipping meals
Sounds, noise Irregular physical activity
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