20 Questions

Headache Questions to Ask Patient

Comprehensive questions to assess headache symptoms, triggers, and impact on daily life for accurate diagnosis and treatment planning.

1

When did the headache first start?

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Why this works

Timing is crucial for diagnosis. Acute onset may indicate serious conditions, while chronic headaches suggest different underlying causes.

2

How would you describe the pain - throbbing, stabbing, pressure, or something else?

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Why this works

Pain characteristics help differentiate between migraine, tension, cluster, and other headache types. Each has distinct pain qualities.

3

Where exactly do you feel the pain - one side, both sides, front, back, or all over?

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Why this works

Location helps identify headache type. Migraines often affect one side, tension headaches typically bilateral, cluster headaches usually unilateral.

4

On a scale of 1-10, how severe is the pain?

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Why this works

Pain intensity helps assess impact on daily function and guides treatment urgency. Severe pain may indicate need for immediate intervention.

5

How long do the headaches typically last?

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Why this works

Duration helps classify headache type. Migraines last 4-72 hours, tension headaches can be shorter, cluster headaches are typically 15-180 minutes.

6

Do you experience any warning signs before the headache starts?

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Why this works

Aura symptoms can indicate migraine with aura, helping differentiate from other headache types and guide treatment approach.

7

What makes the headache worse - light, sound, movement, or certain activities?

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Why this works

Triggers and aggravating factors help identify headache type and guide lifestyle modifications and treatment strategies.

8

Have you noticed any patterns - time of day, day of week, or seasonal occurrence?

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Why this works

Patterns can reveal triggers like hormonal changes, stress cycles, or environmental factors that may be contributing to headaches.

9

Are there any other symptoms that accompany the headache - nausea, vomiting, sensitivity to light or sound?

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Why this works

Associated symptoms are key diagnostic criteria for different headache types and help assess the severity of the condition.

10

What medications have you tried for the headache and how effective were they?

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Why this works

Previous treatment response helps guide current treatment decisions and identifies what has or hasn't worked in the past.

11

How often do you get headaches - daily, weekly, monthly, or less frequently?

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Why this works

Frequency helps classify headache type and assess impact on quality of life, guiding treatment intensity and approach.

12

Have you experienced any recent changes in your sleep, stress levels, or daily routine?

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Why this works

Lifestyle factors are common headache triggers. Changes in sleep, stress, or routine can precipitate or worsen headaches.

13

Do you have a family history of headaches or migraines?

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Why this works

Family history is important as migraines have a genetic component, and family patterns can help predict headache type and treatment response.

14

Have you had any recent head trauma, infections, or other medical conditions?

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Why this works

Recent medical events can be related to headache onset and help identify secondary causes that require different treatment approaches.

15

How do the headaches affect your daily activities - work, school, social life?

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Why this works

Functional impact assessment helps determine treatment urgency and guides disability management and workplace accommodations.

16

What time of day do the headaches typically start?

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Why this works

Timing can reveal patterns related to sleep, stress, or hormonal cycles, and help identify potential triggers or underlying causes.

17

Do you notice any visual changes, numbness, or weakness during or before the headache?

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Why this works

Neurological symptoms can indicate serious conditions requiring immediate attention or help differentiate between headache types.

18

Have you tried any non-medication treatments like relaxation, massage, or dietary changes?

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Why this works

Non-pharmacological approaches are important components of headache management and can reduce medication dependence.

19

Are you currently taking any medications for other conditions?

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Why this works

Other medications can cause headaches as side effects or interact with headache treatments, affecting treatment planning.

20

What would you like to achieve with treatment - pain relief, prevention, or improved function?

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Why this works

Understanding patient goals helps tailor treatment approach and ensures treatment aligns with patient expectations and needs.

Best Practices for Headache Assessment

Expert tips and techniques for getting the most out of these questions.

Best Practices

Use a Systematic Approach

Follow a consistent pattern when asking questions - onset, characteristics, associated symptoms, triggers, and impact. This ensures comprehensive assessment.

Document Everything

Keep detailed records of headache patterns, treatments tried, and patient responses. This helps track progress and guide future treatment decisions.

Consider Red Flags

Always screen for warning signs of serious conditions like sudden onset, neurological symptoms, or changes in headache pattern that require immediate attention.

Question Sequences

The Comprehensive Assessment

1
When did the headache first start?
2
How would you describe the pain?
3
Where exactly do you feel the pain?
4
What makes it worse or better?
5
Are there any associated symptoms?

The Trigger Investigation

1
Have you noticed any patterns?
2
What time of day do they start?
3
Have you had any recent changes?
4
What medications have you tried?
5
How do they affect your daily life?

Common Pitfalls

Don't Rush the Assessment

Headache assessment requires time and patience. Rushing through questions can lead to missed important details and incorrect diagnosis.

Avoid Leading Questions

Ask open-ended questions to get accurate information. Leading questions can bias patient responses and lead to incorrect conclusions.

Don't Ignore Red Flags

Always screen for warning signs of serious conditions. Missing red flags can lead to delayed diagnosis of life-threatening conditions.

Assessment Templates

The Headache History

1
Step 1: Start with: "When did the headache first start?"
2
Step 2: Follow with: "How would you describe the pain?"
3
Step 3: Explore with: "Where exactly do you feel it?"
4
Step 4: Assess with: "What makes it worse or better?"

The Impact Assessment

1
Step 1: Start with: "How often do you get headaches?"
2
Step 2: Follow with: "How long do they typically last?"
3
Step 3: Explore with: "How do they affect your daily life?"
4
Step 4: Assess with: "What would you like to achieve with treatment?"

Further Reading

The Headache Handbook by Dr. Alexander Mauskop
Headache and Migraine Biology and Management by Seymour Diamond
International Classification of Headache Disorders (ICHD-3)

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