Headache assessment
(Redirected from Headache Assessment)
HPI
[edit | edit source]- 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:
[edit | edit source]- General systemic illness: weightloss
- CNS: change in mentation, personality, aura
RED FLAGS OF SERIOUS HEADACHES
[edit | edit source]New onset
[edit | edit source]- headaches beginning at age 40
- mass lesion, temporal arteritis
More SEVERE and FREQUENT headaches (worst headache ever)
[edit | edit source]- mass lesion, subdural hematoma, medication overuse, post-coital headache/migraine
SUDDEN onset (maximal at onset - no increase over time)
[edit | edit source]- 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 | edit source]- 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 | edit source]- Hypertension
- HIV
- Cancer
- Trauma
- Recent procedures
Medication
[edit | edit source]- Analgesic abuse
- Recreational drugs
- Birth control
Family history
[edit | edit source]- Migraines
- Subarachnoid hemorrhage
- Stroke