Headache assessment

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HPI[edit]

  • FIRST or WORST headache ever?
  • DIFFERENT from usual headaches?
  • Onset = when did it start?
    • gradual, sudden (thunder-clap)
  • 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:[edit]

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

RED FLAGS OF SERIOUS HEADACHES[edit]

New onset[edit]

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

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

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

SUDDEN onset (maximal at onset - no increase over time)[edit]

  • 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[edit]

  • 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[edit]

  • Hypertension
  • HIV
  • Cancer
  • Trauma
  • Recent procedures

Medication[edit]

  • Analgesic abuse
  • Recreational drugs
  • Birth control

Family history[edit]

  • Migraines
  • Subarachnoid hemorrhage
  • Stroke

Other OSCE modules[edit]