How should an adult patient with no significant past medical history describe their headache symptoms to a healthcare provider?

How to Describe Your Headache to Your Healthcare Provider

When describing your headache, you must systematically communicate specific characteristics that allow accurate diagnosis: timing and onset, pain location and quality, duration and frequency, associated symptoms, aggravating/relieving factors, and medication use. 1, 2

Essential Information to Provide

Timing and Pattern

• When did the headaches start? State your age at onset and whether this is a new headache pattern or longstanding issue 1
• How often do they occur? Specify the number of headache days per month (e.g., "I have headaches 8 days per month" vs. "I have headaches 20 days per month") 1, 2
• What time of day do they occur? Note if headaches wake you from sleep, occur in the morning, or have predictable timing 1, 3
• How long does each episode last? Describe duration in hours or days (e.g., "each headache lasts 6-8 hours" or "they last 2-3 days") 1

Pain Characteristics

• Where is the pain located? Specify if it's one-sided (unilateral) or both sides (bilateral), front or back of head, or over/behind one eye 1
• What does the pain feel like? Use descriptive words: throbbing/pulsating, pressing/squeezing, sharp/piercing, dull/aching 1, 2
• How severe is the pain? Rate intensity as mild (doesn't stop activities), moderate (interferes with activities), or severe (cannot continue daily activities) 1

Associated Symptoms

• Do you experience nausea or vomiting? This is a critical distinguishing feature for migraine 1, 2
• Are you sensitive to light (photophobia) or sound (phonophobia)? Specify if you need to retreat to a dark, quiet room 1, 2
• Do you have visual disturbances before the headache? Describe any zigzag lines, bright lights, blind spots, or other visual changes that develop gradually over 5-20 minutes 1, 2
• Do you experience numbness, tingling, or weakness? Note which body parts are affected and whether symptoms are one-sided 1, 2

Aggravating and Relieving Factors

• What makes the headache worse? Specify if routine physical activity, coughing, straining, bending over (Valsalva maneuver), or exercise worsens pain 1, 3, 4
• What makes it better? Note if rest, darkness, sleep, or specific positions provide relief 1
• Are there triggers? Mention stress, missed meals, specific foods/beverages consumed in the 24 hours before onset, weather changes, strong odors, or menstrual cycle timing in women 1

Medication History

• What medications have you tried? List all over-the-counter medications (aspirin, ibuprofen, acetaminophen), prescription medications, and natural remedies 1
• How often do you take pain medications? This is critical—specify the exact number of days per month you use acute headache medications, as using non-opioid analgesics ≥15 days/month or other acute medications ≥10 days/month can cause medication-overuse headache 1, 2, 5
• Do the medications work, and for how long? Describe effectiveness and duration of relief 1

Family and Medical History

• Does anyone in your family have migraines or severe headaches? Family history strengthens suspicion for migraine 1
• Do you have other medical conditions? Mention any chronic illnesses, recent infections, or immunocompromised states 3, 6

Red Flag Symptoms That Require Immediate Attention

You must explicitly tell your provider if you experience any of these warning signs: 3, 2

• Sudden, severe headache that peaks within seconds to minutes ("thunderclap" or "worst headache of my life") 3, 2, 6
• New headache after age 50 3, 2, 4
• Headache that worsens with coughing, straining, or bending over 3, 4, 6
• Headache that awakens you from sleep 3, 2
• Progressively worsening headache over days to weeks 3, 2, 4
• Fever, stiff neck, or signs of infection with headache 3, 6
• Any weakness, numbness, vision changes, confusion, or difficulty speaking 3, 6, 7
• Recent head or neck injury 4, 6

Practical Tips for Your Appointment

• Keep a headache diary before your appointment documenting frequency, duration, severity, associated symptoms, triggers, and medication use for at least 2-4 weeks 1, 8
• Bring a list of all medications you've tried, including exact doses and frequency of use 1, 8
• Be specific with numbers: "I have headaches 12 days per month" is more useful than "I have frequent headaches" 2
• Describe the complete attack: what happens before, during, and after the headache 1

Common pitfall to avoid: Patients often underreport how frequently they use over-the-counter pain medications, which can lead to medication-overuse headache—a condition where the medications themselves perpetuate the headache cycle. 1, 5, 8 Be completely honest about all medication use, including pills borrowed from others or obtained without prescription. 8