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Headache HistoryAka: Headache Evaluation

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  1. See Also
    1. Headache
    2. Headache Causes
    3. Headache Examination
    4. Headache Diagnostic Testing
  2. History: Headache Timing
    1. New, Chronic or Recurrent Headache
      1. Acute Headache
        1. Acute Generalized Headache
        2. Acute Localized Headache
        3. Acute Recurrent Headache
      2. Chronic Headache
        1. Chronic Progressive Headache
        2. Chronic Non-Progressive Headache
    2. Duration of chronic Headaches
      1. Headache >4 hours
        1. Migraine Headache: 6 to 36 hours typical
        2. Tension Headache: Constant daily Headache
      2. Headache <4 hours
        1. Autonomic features
          1. Cluster Headache: 30 to 90 minutes
        2. No autonomic features
          1. Trigeminal Neuralgia
  3. History: Organic Headache Assessment
    1. See Headache Red Flag
    2. See Organic Headache
    3. See Acute Generalized Headache
    4. First or worst Headache? (Headache Red Flag)
    5. Headache onset
      1. Gradual onset suggests benign cause
      2. Severe, sudden onset is a Headache Red Flag
  4. History: Headache localization and radiation
    1. Bilateral or Generalized
      1. See Acute Generalized Headache
      2. See Chronic Daily Headache (Tension Headache)
    2. Localized (more significant than generalized)
      1. See Acute Localized Headache
      2. Common primary unilateral Headaches
        1. Cluster Headache
        2. Migraine Headache
        3. Trigeminal Neuralgia
      3. Temporal forehead
        1. Temporal Arteritis
        2. Eye strain (especially with Astigmatism)
        3. Migraine Headache
      4. Trigeminal Nerve distribution
        1. Trigeminal Neuralgia
      5. Jaw pain
        1. Temporomandibular Joint Disorder
      6. Occipital pain
        1. Hypertension
        2. Tension Headache (usually generalized Headache)
        3. Increased Intracranial Pressure
        4. Cervical radiculopathy
        5. Occipital Neuralgia
      7. Eye Pain
        1. Acute Glaucoma
        2. Temporal Arteritis
        3. Acute Sinusitis
        4. Eye strain
        5. Occipital neuralgia due to cervical radiculopathy
        6. Cluster Headache
        7. Migraine Headache
      8. Lower face
        1. Trigeminal Neuralgia
  5. History: Headache characteristics
    1. Pounding Headache
      1. Carbon Monoxide Poisoning
      2. Nitroglycerin or other Vasodilator medications
      3. Migraine Headache
    2. Lancinating Headache (sharp, stabbing pain)
      1. Trigeminal Neuralgia
      2. Occipital neuralgia due to cervical radiculopathy
      3. Ice pick Headache (Migraine variant)
      4. Cluster Headache
    3. Throbbing Headache
      1. Acute Sinusitis
      2. Migraine Headache
    4. Pressure Headache
      1. Tension Headache
  6. History: Demographics
    1. Gender Predominance
      1. Male
        1. Cluster Headache
      2. Female
        1. Hormonal Headache (e.g. Menstrual Migraine)
        2. Basilar Migraine Headache (female adolescents)
    2. Age of Headache onset
      1. Young Child
        1. Hemiplegic Migraine Headache
        2. Ophthalmoplegic Migraine Headache
      2. Older Child, Adolescent and Young adult
        1. Migraine Headache
        2. Tension Headache
        3. Temporomandibular Joint Disorder
        4. Basilar Migraine Headache (female adolescents)
        5. Paroxysmal Hemicrania
          1. Similar to Cluster Headache without Lacrimation
        6. Cluster Headache (rare in children)
        7. Occipital Neuralgia
      3. Adult of middle age and older
        1. See Headaches due to Medication
        2. Temporal Arteritis
        3. Hypertension
        4. Intracranial mass
        5. Cerebrovascular ischemia
        6. Cervical radiculopathy (Cervical Spondylosis)
        7. Chronic Obstructive Pulmonary Disease
        8. Hypnic Headache
  7. History: Associated Symptoms or Signs
    1. Concurrent mental health concerns (e.g. Anxiety)
      1. Tension Headache
    2. Stress provokes Headache
      1. Tension Headache
      2. Migraine Headache
    3. Aura or prodrome
      1. Migraine Headache
      2. Seizure disorder
    4. Lacrimation, Rhinorrhea and facial Flushing
      1. Cluster Headache
    5. Myalgias or Arthralgias
      1. Temporal Arteritis (Polymyalgia Rheumatica)
    6. Exertional Headache
      1. Organic Headache (intracranial mass)
      2. Benign Exertional Headache
    7. Recent Head Trauma
      1. Intracranial bleeding
      2. Post-Concussion Syndrome
    8. Vision related symptoms
      1. Temporal Arteritis
      2. Glaucoma
      3. Migraine Headache (scotomata, photophobia)
    9. Vomiting
      1. Migraine Headache (Nausea)
      2. Increased Intracranial Pressure (no Nausea)
    10. Facial tic
      1. Trigeminal Neuralgia
  8. History: Modifying Factors
    1. Palliative Factors
      1. Headache relieved when removed from environment
        1. Carbon Monoxide Poisoning
      2. Sleep
        1. Migraine Headache
      3. Oxygen at 100% FIO2
        1. Cluster Headache
    2. Provocative Factors
      1. See Migraine Headache Triggers
      2. Current medications
        1. See Rebound Headache
        2. See Increased Intracranial Pressure Causes
        3. See Medication Causes of Headache
  9. References
    1. Cutrer in Goldman (2000) Cecil Medicine, p. 2066
    2. Duman in Friedman (1991) Medical Diagnosis, p. 392-3
    3. Henry in Marx (2002) Rosen's Emergency Medicine, p. 152
    4. Pruitt in Goroll (2000) Primary Care Medicine, p. 931-9

History of headache (C1960629)

ConceptsFinding (T033)
EnglishHistory of headache
Parent ConceptsPMH - past medical history (C0455458)
SourcesSNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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