- Wash hands and introduce yourself
- Check the patient’s name and DOB
- Ask if it’s okay to talk to them before they see the doctor
History of presenting complaint
- Ask what has brought the patient in
- Ask them to expand/tell you more about the headache
- Ask about the pain using SOCRATES mnemonic
- Frontal/occipital/temporal/behind eyes?
- Unilateral or bilateral?
- Shoulder and neck pain?
- Scalp pain/jaw pain on eating? (temporal arteritis)
- Autonomic facial changes?
- Eye watering
- Nasal congestion
- How quickly does the headache come on?
- From first pain until maximum intensity
- Ask about raised ICP/mass
- Dizziness/falls/loss of consciousness
- Worse in the morning?
- Wake from sleep?
- Change in personality
- Focal neurological deficits
- Ask about meningism
- Light sensitivity
- Neck stiffness
- Neurological symptoms
- Loss of/altered consciousness
- Motor or sensory loss
- Changes in vision, speech, hearing
- Ask about stress
- How long have they had headaches for? Is this the first presentation?
- Can do a systems check
- Fits, faints, funny turns
- Weight loss
- Breathing problems/breathlessness
- Digestive problems/abdominal pain
- Waterworks problems
- Problems with bowels
Past medical history
- Do they have any health problems that they see the doctor about?
- Have they ever had:
- Kidney disease
- High blood pressure
- Does anyone in their family have headaches/migraine?
- Does anyone in their close family have any significant illnesses?
- Are they taking any regular medication?
- Do they take any over the counter medication?
- Do they take any supplements?
- Do they have any allergies?
- If yes, to what? What happens?
- With whom/where they live (especially for older patients)
- Ask if the patient has any questions or anything they’re concerned about
- Ask if there’s anything else that you haven’t asked
- Summarise again if necessary
- Thank the patient for their time