Headache History

Below is a template of questions to ask during the history portion of a patient interview in the initial consultation or subsequent followup notes. The template can be carried forward in all future notes.

Headache Characteristics:

  • Initial Onset: ex. childhood, adulthood, later in life, do they remember the exact date?

  • Headache Trigger: ex. MVC, intracranial pathology

  • Frequency: ex. daily, weekly, monthly, yearly…alternatively can ask the amount of headache free days in a week or month

  • Time of day: ex. worse in the morning, afternoon or night

  • Duration: ex. seconds, minutes, hours, days

  • Location: ex. unilateral, frontal sinuses, occipital, holocephalic

  • Quality: ex. pulsating, stabbing, dull, sharp

  • Severity: Pain scale from 0-10

  • Associated symptoms: Nausea, Photo/phonophobia, aura (vertigo, vision changes, hemiplegia, numbness, aphasia, etc), autonomic features

Modifying factors:

  • Identified Triggers: Foods, lack of sleep, stress, etc

  • Relieving factors: Warm or cold compresses, sleep, change in position

Red flags (SNOOPPPP):

  • Systemic signs: Fever, chills, weight loss, chest pain, altered mental status, new seizures (meningitis, malignancy, vascular abnormality?)

  • Neuro symptoms: Focal deficits, altered mental status (mass lesion?)

  • Older onset (>50yo): (increased risk of secondary

  • Onset sudden/thunderclap: (subarachnoid hemorrhage, etc?)

  • Pattern change: Change in quality, frequency, severity etc of the headache with no inciting event

  • Positional involvement: Worse laying flat or sitting up (pressure headache?)

  • Papilledema or pulsatile tinnitus

Prior Therapy:

  • Preventative:

    • Oral:

    • Subcutaneous:

    • Intravenous:

    • Botox:

  • Abortive:

    • Oral:

    • Subcutaneous:

    • Intranasal:

  • Acute Management:

    • Prior ED visits:

      • Responsive to “migraine cocktails” or occipital block:

    • Prior admissions for headache management:

      • Responsive to DHE, depakote, chlorpromazine etc.