Headache assessment

HPI

 * FIRST or WORST headache ever?
 * DIFFERENT from usual headaches?


 * Onset = when did it start?
 * gradual, sudden (thunder-clap)
 * prodrome, aura
 * Palliation/Provocative
 * stress, food, menstrual cycle, rest
 * Quality
 * unilateral, bilateral, band-like?
 * does it spread?
 * throbbing, stabbing, dull, pressure
 * Radiation
 * where does it spread?
 * Severity
 * Nausea/vomiting
 * photo/phonophobia
 * vision changes
 * fever
 * stiff neck
 * confusion

Review of systems:

 * General systemic illness: weightloss
 * CNS: change in mentation, personality, aura

New onset

 * headaches beginning at age 40
 * mass lesion, temporal arteritis

More SEVERE and FREQUENT headaches (worst headache ever)

 * mass lesion, subdural hematoma, medication overuse, post-coital headache/migraine

SUDDEN onset (maximal at onset - no increase over time)

 * SAH, mass lesion (especially in the posterior fossa)
 * new onset in patient with risk factors for HIV or CANCER
 * meningitis, brain abscess, metastasis

headache ASSOCIATED with

 * fever (meningitis, encephalitis, systemic infection)
 * projectile vomiting
 * impaired mental status
 * focal neurological signs - weakness, paresthesia (mass lesion, stroke)
 * recent head injury
 * papilledema (mass lesion, pseudotumor, meningitis)
 * meningismus (meningeal irritation)
 * seizures
 * trauma (intracranial hemorrhage, subdural/epidural hematoma, SAH)

PMHx

 * Hypertension
 * HIV
 * Cancer
 * Trauma
 * Recent procedures

Medication

 * Analgesic abuse
 * Recreational drugs
 * Birth control

Family history

 * Migraines
 * Subarachnoid hemorrhage
 * Stroke