Headache assessment

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Contents 1 HPI 2 RED FLAGS OF SERIOUS HEADACHES 2.1 New onset 2.2 More SEVERE and FREQUENT headaches (worst headache ever) 2.3 SUDDEN onset (maximal at onset - no increase over time) 2.4 headache ASSOCIATED with 3 PMHx 4 Medication 5 Family history 6 Other OSCE modules

[edit] HPI

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

• Onset = when did it start?
  • gradual, sudden (thunder-clap)
• Palliation/Provokative
  • 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

[edit] RED FLAGS OF SERIOUS HEADACHES

[edit] New onset

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

[edit] More SEVERE and FREQUENT headaches (worst headache ever)

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

[edit] 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

[edit] 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)

[edit] PMHx

• hypertension
• HIV
• cancer
• trauma
• recent procedures

[edit] Medication

[edit] Family history

[edit] Other OSCE modules