Headache history Flashcards
1
Q
What do you ask in headache history (SOCRATES)?
A
Site
-ask them to point to where it is
Onset
-sudden onset: subarachnoid haemorrhage or cerebral vein thrombosis (go on to ask about meningitism features)
Character
-dull/throbbing/pulsating (could be migraine etc)
Radiation
- ask them if it spreads to face: trigeminal neuralgia
- ask them if it spreads to the neck: SAH or meningitis
- ask them if it spreads to the eye: angle closed glaucoma
Associated symptoms
-ask them red flag symptoms
Time
-ask them if it is worse in any particular time of the day: morning-> indicates raised intracranial pressure
Exacerbating and Relieving factors
-lying down or coughing making it worse-> raised intracranial pressure
Severity (1-10)
2
Q
What other things can you ask about headaches?
A
- is there anything you do when you have a headache
- go to a dark and quiet room: migraine. ask them if they see any flashing lights
- pace around the room in agitated state: cluster headache
3
Q
What are the red flag symptoms that you must ask in headache history?
A
- fever nausea, vomiting; neck stiffness; photophobia (sensitivity to light)-meningitis
- head trauma
- non-blanching rash-meningococcal sepsis
- worse when lying down or coughing-raised intracranial pressure due to space occupying lesion
- neurological deficits like pins and needles/muscle weakness/loss of consciousness-> space occupying lesion
- constitutional symptoms like night sweats and weight loss
- any pain when brushing hair/scalp-> giant cell arteritis
4
Q
What are important questions to ask for PMH/SH
DH
FH
SH
A
PMH/SH:
- ask for recent head trauma-> subdural haemorrhage
- ask for any bleeding or clotting disorders
- ask them if they had this before
DH:
- ask them for any blood-thinning medications
FH:
- ask them for bleeding or clotting disorders (thrombophilias)
- ask them if anyone in family had any headaches
- ask them if anyone had bleeding in brain (ADPCKD)
SH:
- occupation
- carer
- ETOH/smoking/RD
ICE
