What is the appropriate evaluation and management approach for a patient presenting with a headache, considering their age, medical history, and potential underlying conditions?

Paano Mag-Chief Complaint Charting sa Masakit ang Ulo

Isulat ang chief complaint bilang "Sakit ng ulo" o "Headache" kasama ang duration (halimbawa: "Sakit ng ulo, 2 araw na"), at agad na kunin ang specific history para ma-classify kung primary o secondary headache disorder at ma-identify ang red flags na nangangailangan ng urgent evaluation. 1, 2

Essential History Components na Dapat Itanong

Magtanong ng mga sumusunod na detalye para sa kompletong documentation:

Timing at Pattern

• Kailan nagsimula: Bagong sakit ng ulo pagkatapos ng edad 50 ay red flag para sa secondary causes 2, 3
• Gaano kadalas: ≥15 araw bawat buwan sa loob ng >3 buwan ay maaaring chronic migraine 1
• Gaano katagal: Migraine ay tumatagal ng 4-72 oras kapag hindi ginagamot 1
• Anong oras nangyayari: Gumigising ba sa gabi mula sa tulog (red flag) 2, 4

Pain Characteristics (OPQRST Format)

• Lokasyon: Isang gilid lang (unilateral) o pareho (bilateral) 1
• Kalidad: Tumitibok (pulsating), sumasakit, pumipiga 1
• Severity: Banayad, katamtaman, o matindi; lumalala ba sa routine activities tulad ng paglakad o pag-akyat ng hagdan 1
• Aggravating factors: Lumalala ba sa Valsalva maneuver, pag-ubo, o physical exertion (red flag) 2, 4

Associated Symptoms

• Kasama bang: Pagduduwal (nausea), pagsusuka (vomiting), takot sa liwanag (photophobia), takot sa ingay (phonophobia) 1, 5
• May aura ba: Visual disturbances, sensory changes, speech problems na tumatagal 5-60 minuto 1
• Neurologic symptoms: Focal weakness, numbness, vision changes, confusion (red flag) 2, 3
• Systemic symptoms: Lagnat, scalp tenderness, jaw claudication (red flag para sa giant cell arteritis) 2, 3

Red Flags na Dapat I-document

• "Thunderclap" onset: Biglang matinding sakit (worst headache of life) 2, 3
• Progressive worsening: Patuloy na lumalala ang pattern 2, 4
• Recent head trauma: Kamakailang injury sa ulo o leeg 4
• Pregnancy status: Kung buntis ang pasyente 4
• Cancer o immunosuppression history: Mas mataas ang risk ng secondary causes 5

Medication History

• Anong gamot na tinry: Over-the-counter o prescribed medications 1
• Gaano kadalas gumagamit: ≥15 araw/buwan ng analgesics o ≥10 araw/buwan ng triptans ay medication-overuse headache 1
• Effective ba: Tumutulong ba at gaano katagal 1

Triggers at Lifestyle Factors

• Pagkain at inumin: Specific foods, caffeine, alcohol 1
• Stress, tulog, exercise patterns 1
• Hormonal factors: Sa mga babae, may kaugnayan ba sa menstrual cycle 1

Family History

• May history ba ng migraine sa pamilya: Strong genetic component ng migraine 1

Physical Examination Findings na Dapat I-document

• Vital signs: Lalo na blood pressure (hypertension ay maaaring cause) 3
• Neurologic examination: Mental status, cranial nerves, motor/sensory function, reflexes, gait 3, 4
• Fundoscopic exam: Para sa papilledema (sign ng increased intracranial pressure) 3
• Scalp at temporal artery palpation: Tenderness ay red flag para sa giant cell arteritis 2, 3
• Neck examination: Meningismus, range of motion 4

Assessment at Plan na Dapat Isama

Kung walang red flags at consistent sa primary headache:

• I-classify kung migraine without aura, migraine with aura, tension-type, o cluster headache base sa ICHD-3 criteria 1
• Acute treatment plan: NSAIDs (ibuprofen 400-800 mg, naproxen 500-825 mg) bilang first-line 2, 6
• Preventive therapy consideration kung ≥2 attacks/month na may disability ≥3 days 2, 3

Kung may red flags:

• Urgent neuroimaging (MRI with at without contrast preferred) 2, 3
• ESR at CRP kung suspected giant cell arteritis 3
• Immediate referral o emergency evaluation 2

Common Pitfalls na Iwasan

• Huwag mag-assume na benign: Bagong sakit ng ulo sa edad >50 ay kailangang i-workup para sa secondary causes 2, 3, 4
• Huwag mag-overprescribe ng acute medications: Medication overuse ay nagiging sanhi mismo ng chronic headache 1
• Huwag mag-routine neuroimaging: Kung normal ang neuro exam at walang red flags, hindi kailangan ng imaging 2
• Huwag gumamit ng opioids: Limited efficacy at mataas ang risk ng dependency at rebound headaches 2, 6