What clinical history should be taken for a 61-year-old female patient presenting with a headache due to a meningioma?

Clinical History for a 61-Year-Old Female with Meningioma-Related Headache

A thorough clinical history for a 61-year-old female with meningioma-related headache should focus on headache characteristics, associated neurological symptoms, and risk factors to guide appropriate management and reduce morbidity and mortality.

Headache Characteristics

• Document onset, duration, frequency, and pattern of headaches, noting if they have progressively worsened over time 1, 2
• Assess pain characteristics including location (unilateral vs bilateral), quality (pulsating, pressure), and severity using a numerical scale 2
• Determine if headaches awaken the patient from sleep, which may indicate increased intracranial pressure 2, 3
• Ask if headaches are worsened by Valsalva maneuver (coughing, straining), which suggests increased intracranial pressure 2, 3
• Document any aggravating or alleviating factors, including response to analgesics 2

Associated Neurological Symptoms

• Inquire about symptoms of raised intracranial pressure (nausea, vomiting, drowsiness) 1
• Assess for visual disturbances (blurred vision, diplopia, visual field defects) which may indicate compression of visual pathways 1
• Document any focal neurological deficits affecting the limbs, which may correlate with tumor location 1
• Ask about cranial nerve symptoms (hearing loss, facial numbness, difficulty swallowing) 1
• Evaluate for seizure activity, which occurs in up to 30% of meningioma patients 1
• Inquire about mental status changes, including personality changes or cognitive decline 1
• Document gait difficulties or balance problems which may indicate cerebellar involvement 1

Timing and Progression

• Determine the duration of symptoms and whether they have been stable or progressive 3
• Ask if this is a new headache pattern or similar to previous headaches 3
• Document any recent changes in headache intensity, frequency, or associated symptoms 2, 3

Risk Factors and Medical History

• Ask about history of radiation exposure, which increases risk of meningioma 1
• Inquire about family history of neurofibromatosis or other genetic syndromes associated with meningiomas 1, 4
• Document history of previous intracranial tumors or surgeries 4
• Ask about current medications, particularly hormonal therapies that might influence meningioma growth 4, 2

Impact on Daily Life

• Assess how headaches affect daily activities, work performance, and quality of life 4, 2
• Document any functional limitations resulting from headaches or other neurological symptoms 4
• Ask about sleep disturbances related to headaches 3

Red Flags Requiring Urgent Attention

• Document any sudden onset of severe headache ("worst headache of life") which may indicate hemorrhage 3
• Ask about fever or signs of infection which could suggest meningitis 3
• Note any rapid progression of neurological deficits which may indicate acute complications 1

Diagnostic History

• Document previous brain imaging studies and their findings 1
• Ask about previous treatments attempted for headaches and their effectiveness 2, 3
• Note any prior neurosurgical consultations or recommendations 4

Special Considerations for Meningiomas

• In meningiomas located at the skull base or petroclival region, patients often report a "difficult to describe headache" as a prominent feature 1
• For patients with intraventricular meningiomas, headaches are often severe and localized to the occipital region 5
• Cystic meningiomas may present with headaches resistant to usual analgesics along with behavioral disorders 6

Understanding these specific clinical history elements will help guide appropriate management decisions and improve outcomes for patients with meningioma-related headaches.