Medically Fit For Exams
Medically Fit For Exams

Headache history taking

  • 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

 

Site

Onset

Character

Radiation

Associated symptoms

Time-course

Exacerbating/relieving factors

Severity

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?
    • Pulsing/throbbing/thunderclap/tightness?
    • Shoulder and neck pain?
    • Scalp pain/jaw pain on eating? (temporal arteritis)
    • Autonomic facial changes?
      • Eye watering
      • Nasal congestion
    • Nausea/vomiting?
    • Aura
      • Changes in vision
    • 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
    • Constant/progressive?
    • Focal neurological deficits
  • Ask about meningism
    • Light sensitivity
    • Neck stiffness
    • Fever
  • Neurological symptoms
    • Loss of/altered consciousness
    • Motor or sensory loss
    • Incontinence
    • 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:
    • Stroke/TIA
    • Kidney disease
    • Epilepsy
    • Cancer
    • High blood pressure

 

Family history

  • Does anyone in their family have headaches/migraine?
  • Does anyone in their close family have any significant illnesses?
    • Cancer
    • Heart disease

 

Drug history

  • Are they taking any regular medication?
    • Including the pill
  • Do they take any over the counter medication?
  • Do they take any supplements?

 

Allergies

  • Do they have any allergies?
    • If yes, to what? What happens?

 

Social history

  • Smoker?
  • Alcohol?
  • Occupation?
    • Is it stressful?
  • With whom/where they live (especially for older patients)

 

Summary

  • 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
Headache history taking.docx
Microsoft Word document [18.2 KB]

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