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