Headache

HISTORY_LIST
sudden onset
gradual onset
age at onset
duration
quality
dull
sharp
band like
pulsating
throbbing
location is bilateral
location is unilateral
time course
interferes with daily activities
pain free periods
radiation of pain to back
radiation of pain to shoulder
associated myalgias
exacerbating factors
exacerbated by foods
chocolate
citrus
alcohol
wine
cheese
hot dogs (nitrate HA)
tyramine
exacerbated by emotional upset
exacerbated by menses
exacerbated by ovulation
exacerbated by hypertension
exacerbated by trauma
exacerbated by lack of sleep
exacerbated by excessive sleep
exacerbated by fatigue
exacerbated by exertion
exacerbated by sex
exacerbated by coughing
exacerbated by MSG
exacerbated by sinusitis
exacerbated by fumes
relieving factors
time of day
periodicity
effect of supine position
change in severity
suddenly awaken from sleep
"the worst headache ever"
prodromal aura noticed
scotomata
scintillating zigzag lines
blurred vision
transient blindness
nausea vomiting
numbness
weakness
dizziness
lethargy
diplopia
photophobia
sonophobia
fever
neck stiffness
syncope
eye pain or redness
ataxia
dysarthia
facial pain
tooth pain
sleep disturbance
low energy
loss of interest
poor concentration
sadness
INFECTIOUS DISEASES
sinusitis
CHRONIC DISEASES OR DISORDERS
hypertension
benign intracranial hypertension
temporal arteritis
meningitis
encephalitis
herpes zoster
glaucoma
pheochromocytoma
intracranial tumor
venous sinus thrombosis
trigeminal neuralgia
occipital neuralgia
hypoxia
SURGERY/PREVIOUS HOSPITALIZATIONS
head surgery
facial surgery
major dental/oral surgery
PREVIOUS TESTS
MRI of head
CT of head
TRAUMA OR INJURIES
head trauma
concussion
subdural hematoma
SOCIAL HISTORY
smoking
alcohol
caffeine
illicit drugs - cocaine
ALLERGY
medications
foods
seasonal
FAMILY HISTORY
migraine headaches

MEDS_LAB_TESTS
**** MEDS
nitrates
calcium channel blockers
phenothiazines
sedatives
theophyllline
sympathomimetics
estrogen
MAO inhibitors
indomethacin
cimetidine
ranitidine
co-trimoxazole
hydralazine
dipyridamole
corticosteroids
excessive ergotamine
cold remedies
eye drops
diet pills
cocaine
****LAB
Electrolytes
BUN
creatnine
CBC
ESR
**** TESTS
lumbar puncture
CT scan of head

REVIEW_OF_SYSTEMS_1
GENERAL
weight changes
appetite changes
anorexia
difficulty sleeping
fever
chills
polyphagia
hypophagia
changes in thirst
sleeping habit change
bowel habit change
fatigue
hypertension
previous physical exams
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethora
neurofibromatosis lesion
HEENT
head trauma
skull fractures
head masses
hearing loss
vertigo
chronic ear infection
ear discharge
ear pain
hearing aid use
loss of vision
recent change in vision
photophobia
diplopia (double vision)
glaucoma
exudates
dry eyes
eye pain
cataracts
eye surgery
itchy eyes
excessive tearing
corrective lenses
nose bleeds
chronic sinusitis
nasal fractures
nasal drainage
polyps
changes in sense of smell
edentulous (without teeth)
partial plate
full plate
recent dental work
oral lesions
tonsillitis
strep throat
tongue problems
voice changes
chronic hoarseness
chronic halitosis
NECK
neck masses
enlarged thyroid gland
brachial cleft cysts
neck injury

REVIEW_OF_SYSTEMS_2
CHEST
chronic coughing
sputum production
hemoptysis
wheezing
pneumonia
bronchitis
TB
TB exposure
SOB (altered by position?)
edema
chest pains
pacemaker
HEART
MI
coronary artery disease
heart murmur
heart valve disease
left ventricular hypertrophy
mistral valve stenosis
pericarditis
palpitations
DOE
paroxysmal nocturnal dyspnea
orthopnea
edema
hypertension
rheumatic fever
cardiomyopathy
ectopic heart beats
arrhythmia
exercise intolerance
claudication
heart medications
ABDOMEN
abdominal pain
nausea
vomiting
diarrhea
constipation
hematochezia
hematemesis
hemorrhoids
GI x-rays
GI scopings
rectal bleeding
ulcers
bowel polyps
bowel incontinence
gall bladder disease
gall stones
hepatitis
cirrhosis
hepatomegaly
splenomegaly
GU
renal insufficiency
renal failure
dialysis
kidney stones
kidney disease
kidney cyst
flank pain
hematuria
pyuria
dysuria
chronic cystitis
nocturia
anuria
hesitancy
enuresis
change in urine color
prostatitis
epididymitis
scrotal problems
TURP
pain on intercourse
genital lesions
genital discharge

REVIEW_OF_SYSTEMS_3
OB/GYN
metorrhagia
menorrhagia
irregular menses
problems in pregnancy
use of contraception
breast masses
nipple discharge
breast skin changes
changes in axillary nodes
monthly breast exam
breast feeding children
EXTREMITIES
difficulty with gait
weakness
joint swelling
joint stiffness
muscle pain
muscle swelling
muscle injuries
sagittal plan scoliosis
coronal plane scoliosis
fractured bones
SLE
osteoarthritis
rheumatoid arthritis
fibromyalgia
NEURO
seizures
head injury
LOC
loss of coordination
difficulty in balance
sciatica
difficulty in fine motor skills
difficulty speaking
CVA (stroke)
weakness in arms
weakness in legs
tingling in legs and feet
tingling in arms
PSYCHIATRIC
depression
bipolar disorder
suicide attempts
psychiatric hospitalizations
personality disorders
ENDOCRINE
goiter
exophthalmos
dry skin
dry hair
intolerance to heat
intolerance to cold
changes in growth
sterility
impotence
decreased libido
LYMPHATIC AND HEMATOLOGICAL
lymphadenopathy
transfusion
anemia


PHYSICAL_EVAL_1
VITALS
BP
Pulse
Temp
Heart rate
GENERAL
complaining of a headache
wincing in pain
sensitive to light
SKIN
facial "peau d'orange" skin
petechiae
stria
(neuorfibromatosis)
adenoma sebaceum
hypopigmented ash leaf spots
herpetic lesions
HEENT
cranial tenderness
asymmetric pupils size
asymmetric pupil reaction
papilledema
loss of venous pulsation
retinal hemorrhages
extraocular movements
nystagmus
decreased visual fields
conjuctival injection
lacrimation
rhinorrhea
jaw pain
TMJ pain
temporal bruits
ocular bruits
tenderness of temporal artery
thickening of temporal artery
facial tenderness
sinus tenderness
dental carries
tooth tenderness to percussion
tympanic membrane inflammation
hemotympanum (basal skull fx)
paranasal muscle tension
eyelid ptosis
miosis
anhydrosis

PHYSICAL_EVAL_2
NECK
neck rigidity
NEURO
mental status
cranial nerve palsies
hearing acuity
local weakness
hemiparesis
coordination
deep tendon reflexes
ataxia
Babinski's sign

INDICATIONS FOR CT SCAN
focal neurologic signs
papilledema
decreased visual acuity
increased frequency of HA
increased severity of HA
excruciating HA
paroxysmal HA
HA awakening from sleep
persistent vomiting
recurrent morning HA
head trauma with ->
  focal neurologic signs
head trauma with lethargy

DIFF_DIAGNOSIS
Classic migraine HA
Common migraine HA
Cluster migraine HA
Tension HA
systemic infection
subarachnoid hemorrhage
drug related HA
cerebral embolism
sinusitis
arteriovenous malformation
malignant hypertension
temporal arteritis
viral meningitis
bacterial meningitis
encephalitis
post concussion/trauma syndrome
intracranial tumor
venous sinus thrombosis
pressor reaction
cerebrovascular insufficiency
benign intracranial hypertension
subdural hematoma
trigeminal neuralgia
post herpetic neuralgia
facial pain
occipital neuralgia
glaucoma
pheochromocytoma
brain abscess
analgesic overuse
food allergy
hypoxia
neuorfibromatosis 
facial angiofibromas
tuberous sclerosis 
psychogenic
TENSION HEADACHE INDICICATORS
bilateral
generalized pain
bitemporal or suboccipital pain
band like pressure
may throb
usually occurs late in the day
related to stress
rarely associated with N & V
lasts for hours or days
onset in adolescence or young adult
CLASSIC MIGRAINE CHARACTERISTICS
childhood to early adult onset
family history
more common in women
scotomas or scintillations
unilateral throbbing pain
nausea and vomiting
last 2 - 6 hours
relieved with sleep
triggered by :
  wine, cheese, 
  chocolate, contraceptives
  exercise, travel
COMMON MIGRAINE CHARACTERISTICS
unilateral or bilateral
nausea
rarely  with vomiting
rarely  with visual complaints
lasts for hours or days
more common in women
more gradual onset 
 than classic migraine HA
CLUSTER MIGRAINE CHARACTERISTICS
recurrent
nocturnal
unilateral, retroorbital
  searing pain
lacrimation
nasal and conjunctival congestion
Young males awakened 2-4 hours 
  after sleep onset
last 20-60 minute
occurs in clusters at same time
 of night or several times each
 day over several weeks
 followed by pain free periods 
 of months or years


