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    Headache History: Introduction - WIPPP

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    Amjad_2020
    The patient presented with a headache. Their medical history was taken including details of the headache such as location, onset, character, radiation, exacerbating/relieving factors and severity. Red flags like recent trauma, neurological symptoms, vomiting and fever were assessed. The patient's past medical, surgical, medication and family histories were also obtained. Finally, their social history including smoking, diet, sleep, stressors and occupation was documented.

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    Headache History: Introduction - WIPPP

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    Amjad_2020
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    The patient presented with a headache. Their medical history was taken including details of the headache such as location, onset, character, radiation, exacerbating/relieving factors and severity. Red flags like recent trauma, neurological symptoms, vomiting and fever were assessed. The patient's past medical, surgical, medication and family histories were also obtained. Finally, their social history including smoking, diet, sleep, stressors and occupation was documented.

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    Headache Hx for MS

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    Headache History

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    The patient presented with a headache. Their medical history was taken including details of the headache such as location, onset, character, radiation, exacerbating/relieving factors and severity. Red flags like recent trauma, neurological symptoms, vomiting and fever were assessed. The patient's past medical, surgical, medication and family histories were also obtained. Finally, their social history including smoking, diet, sleep, stressors and occupation was documented.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    150 views4 pages

    Headache History: Introduction - WIPPP

    Uploaded by

    Amjad_2020
    The patient presented with a headache. Their medical history was taken including details of the headache such as location, onset, character, radiation, exacerbating/relieving factors and severity. Red flags like recent trauma, neurological symptoms, vomiting and fever were assessed. The patient's past medical, surgical, medication and family histories were also obtained. Finally, their social history including smoking, diet, sleep, stressors and occupation was documented.

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    of 4

    Headache History

    Introduction –WIPPP
    • Wash hands
    • Introduce yourself and confirm the patient’s name, age
    • Privacy: Insure patient’s Privacy
    • Permission: Gain consent with explaining what you are going to do.
    • Pain: ask if the patient is currently in pain.
    Presenting complaint (PC)
    • What brought you to the clinic (or ER)?
    • Age: temporal arteritis in old people
    History of presenting complaint (HBC)
    A) Analysis of pain (SOCRATES)
    • Site: Where exactly is the pain?
    o Exact site: front, temporal, occiptal
    ▪ Face/in front of ear  (Trigeminal neuralgia)
    ▪ Temporal  (temporal arteritis)
    ▪ Unilateral (Migraine), or bilateral  tension headache
    • Onset: When did it start?
    o Constant or intermittent?
    o Gradual or sudden? (Sudden  Subarachnoid hemorrhage), (slowly progressive 
    migraine) (progressive  subdural hematoma)
    o Periodic (e.g. every month), correlation with menstruation
    • Character: What is the pain like e.g. dull, pressure, burning, throbbing?
    o Throbbing  Migraine
    o Thunder-like  Subarachnoid hemorrhage
    o Tight  tension headache
    • Radiation: Does the pain radiate/move anywhere? (Neck  Subarachnoid hemorrhage)
    o neck (meningitis) / face (e.g. trigeminal neuralgia) / eye (e.g. acute closed angle
    glaucoma)
    • Associations: Is there any symptoms that present before or with the headache? And for
    how long does it last?
    o (Migraine):
    ▪ Nausea, vomiting, phonophobia
    ▪ Visual disturbances:
    • positive symptoms (e.g. scintilla (flash light), scotomas (blind spots), scintillating
    scotoma (zigzag lines))
    o (Cluster headache): ipsilateral nasal congestion, lacrimation, periorbital pain, eye redness,
    rhinorrhea, and Horner's syndrome
    o (Temporal arteritis): dizziness, blurred vision, jaw claudication, proximal limb pain
    o (Sinusitis): facial pain, anosmia, fullness behind eye and cheeks, postnasal drip, rhinorrhea
    o (Meningitis)  Photophobia, fever, stiff neck and rash
    o Increased ICP nausea, projectile vomiting, decreased LOC, weakness, seizures…
    o Transient loss of consciousness  If the patient lost consciousness, take history from witness
    of symptoms before during and after the TLOC
    • Time course:
    o Diurinal variation: early morning headache  Increased ICP
    o Duration of headaches (with or without Treatment)
    o How long did it last before it reached its maximum pain?
    o Duration of pain-free periods
    • Exacerbating/relieving factors:
    o Exacerbating:
    ▪ Touching scalp (temporal arteritis)
    ▪ Cough, straining/bending down/coughing  Increased ICP
    ▪ Light, noise, activity (migraine, meningitis)
    ▪ Sexual activity?
    ▪ Specific types of food
    o Relieving:
    ▪ Rest, medication, sitting in the dark.
    ▪ Persistent headache not responsive to analgesics  tension headache
    • Severity;
    o How severe is the pain? consider using the 1-10 scale.
    o Does it affect daily life? Awakens the patient from sleep?
    B) Red Flags
    a. Recent Trauma
    b. Focal Neurological symptoms; speech difficulty, weakness, numbness, Loss of consciousness
    c. Vomiting
    d. Worse in the morning/on waking up
    e. Sudden onset
    f. Fever
    g. Scalp tenderness
    h. Past medical history of cancer or HIV

    Differential diagnoses of headache


    Intracranial Extracranial Systemic
    • Inflammation: Referred pain from eyes, ears, • HTN
    o Meningitis nose, sinuses or teeth • Hypoglycemia
    o Encephalitis • Fever
    o Cerebral abscess • Drug-induced e.g. triptan,
    painkillers
    • Vascular: • Psychogenic
    o Migraine
    o Temporal arteritis
    o Cluster headache

    • Increased ICP
    • Brain tumor
    1- Past medical
    • Previous episodes of headache. Is it the same or worse? (IF Dxed w/ headache ask about meds
    compliance)
    • Head trauma
    • Recovered visual loss (Multiple Sclerosis)
    • Stroke
    • Chronic diseases, e.g. diabetes, hypertension
    • Malignancy

    2- Past surgical history (PMH)


    • Have you undergone any type of surgeries?

    3- Drug history (DH)


    • Find out what medications the patient is taking, dosage, specifically ask about:
    o Analgesics (overuse?  rebound headache)
    o Oral Contraceptives  when stopped menstrual-related headache, migraine.

    • Allergies
    • Vaccination history  bacterial meningitis

    4- Family history (FH)


    • Does anyone in your family have similar complain?
    • Conditions within the family. Is there any condition that runs in your family, including chronic diseases?
    o Migraines (‫)الشقيفي‬ o Malignancy

    5- Social history (SH)


    ▪ Smoking
    ▪ Diet and caffeine intake
    ▪ Sleep
    ▪ Occupation
    ▪ Does he use any illegal substances, eg alcohol, cannabis, cocaine, etc.
    ▪ Stressors: (financial, occupational, relationship)
    6- Systemic review (see appendix)
    7- Concluding the interview

    Ideas – what are the patient’s thoughts regarding their symptoms?

    Concerns – explore any worries the patient may have regarding their symptoms

    Expectations – gain an understanding of what the patient is hoping to achieve from the consultation
    Is there anything else you would like to talk about? Then thank the patient

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