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- FIRST or WORST headache ever?
- DIFFERENT from usual headaches?
- Onset = when did it start?
- gradual, sudden (thunder-clap)
- prodrome, aura
- stress, food, menstrual cycle, rest
- unilateral, bilateral, band-like?
- does it spread?
- throbbing, stabbing, dull, pressure
- where does it spread?
- vision changes
- stiff neck
Review of systems:
- General systemic illness: weightloss
- CNS: change in mentation, personality, aura
RED FLAGS OF SERIOUS HEADACHES
- headaches beginning at age 40
- mass lesion, temporal arteritis
More SEVERE and FREQUENT headaches (worst headache ever)
- mass lesion, subdural hematoma, medication overuse, post-coital headache/migraine
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
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)
- trauma (intracranial hemorrhage, subdural/epidural hematoma, SAH)
- Recent procedures
- Analgesic abuse
- Recreational drugs
- Birth control
- Subarachnoid hemorrhage