Essential Questions for Headache History Taking
A comprehensive headache assessment requires specific questions about frequency, characteristics, associated symptoms, and red flags to distinguish between primary and secondary headache disorders and guide appropriate management.
Core Questions for All Headache Patients
- Ask "Do you feel like you have a headache of some type on 15 or more days per month?" to screen for chronic headache disorders 1
- Determine frequency and timing: "How frequent are the headaches?" and "What time of day do the headaches occur?" 1
- Assess pain characteristics: "What is the character of the pain: dull, aching, throbbing, piercing, squeezing, excruciating?" 1
- Identify location: "Where is the pain located? One or both sides of the head? Front or back of the head? Over or behind one eye?" 1, 2
- Determine duration: "How long do the headaches last? Hours, days?" 1, 2
- Inquire about associated symptoms: "What other symptoms accompany the headache? Nausea or vomiting? Dizziness? Head/neck muscles contracting? Are the senses (eyesight, hearing, touch) affected?" 1, 3
Red Flag Assessment Questions
- Ask about sudden onset: "Have you ever experienced an abrupt onset of severe headache?" to screen for subarachnoid hemorrhage 1, 4
- Determine if headache awakens patient from sleep: "Do these headaches ever awaken you from sleep?" which may indicate increased intracranial pressure 1, 2
- Assess for Valsalva-related worsening: "Does the headache worsen when you cough, strain, or bend over?" which may suggest increased intracranial pressure 1, 2, 5
- Inquire about age of onset: "When did these headaches first begin?" as new headache after age 50 requires further investigation 2, 4, 6
- Ask about progression: "Are your headaches getting progressively worse?" which may indicate a mass lesion 1, 4, 5
Medication and Treatment History
- Assess current medication use: "Do you take over-the-counter medications for your headaches? Did another doctor prescribe a medication? Does it work and for how long? Do you take any natural remedies or herbs?" 1
- Screen for medication overuse: "How many days per month do you take medication for headaches?" as use on >10 days/month can lead to medication overuse headache 1, 3, 7
- Evaluate previous treatments: "Have you ever been evaluated for these headaches? If so, what was the result?" 1
Trigger and Pattern Assessment
- Identify potential triggers: "When the headaches occur, have you eaten a meal or snack recently, or have you missed a meal? If you have eaten, what foods did you eat and what beverages did you drink within the past 24 hours?" 1
- Assess environmental factors: "What is the weather like when the headaches occur? Are you exposed to any odors such as perfume, chemicals, or smoke when the headaches occur?" 1
- Evaluate stress relationship: "When you have these headaches, are you under any stress?" 1
- For women, ask about menstrual relationship: "Do the headaches occur during your menstrual cycle?" 1
- Inquire about situational context: "Where are you when the headaches occur? Home, office, shopping, etc.?" 1
- Ask about sexual activity: "Do the headaches ever occur during sexual activity?" which may indicate certain secondary headaches 1
Family and Sleep History
- Determine family history: "Is there a history of headaches in your family?" 1
- Assess sleep patterns: "What are your sleeping patterns?" 1
- Screen for psychiatric comorbidities: Consider asking about symptoms of depression and anxiety, as these are commonly comorbid with headache disorders, especially migraine and medication overuse headache 8, 7
Documentation Recommendations
- Have patients maintain a headache diary to accurately track frequency, duration, and characteristics, as patients often underreport milder headaches 1
- Document presence or absence of aura symptoms to help classify headache type 2, 3
- Record impact on daily functioning to assess severity and guide treatment decisions 1, 9