- Have you got the headache at present?
- Have you had this type of headache before?
- How often do you get the headaches?
- How long do the headaches last?
- Where exactly is the headache?
- How would you describe the headache?
- Gradual or sudden onset of the headache?
Why: If sudden and severe headache must consider possibility of subarachnoid hemorrhage.
- Is there anything that will bring the headaches on, or worsen the headache?
Why: e.g. exertion such as coughing, sneezing, stooping, straining, lifting and various sporting activities (exertional headache); after sexual intercourse (post-coital headache); migraines may be triggered by many factors including certain foods, alcohol, bright light, glare, emotional stress, allergens, excessive noise, strong perfume, tiredness, stress, relaxation after stress, exercise, menstruation or pregnancy; cluster headaches may be aggravated by alcohol; headaches from cervical spondylosis may be aggravated by moving the neck.
- Is there anything that can relieve the headaches?
Why: e.g. migraines are relieved with sleeping; tension headaches may be relieved by alcohol; headaches due to cervical spondylosis or dysfunction may be relieved by heat or cold compresses to the neck.
- What time of the day is the headache worse?
Why: e.g. if patient wakes with the headache consider migraine, cervical spondylosis, depression, hypertension or brain tumor; frontal sinusitis often starts at around 9am and builds to a maximum at around 1 pm, then subsides over the next few hours; cluster headaches often start suddenly through the night around 2-3 hrs after falling asleep.
- Are you under a lot of stress or tension?
Why: may suggest tension headache (commonest cause of chronic recurrent headache).
- Have you had a heavy cold recently?
Why: may suggest cause of headache is a respiratory infection (this is the most common cause of headache) or sinusitis.
- Recent head injury?
Why: may suggest concussion, post-concussion headache, extradural haematoma, subdural haematoma or headache from cervical spondylosis or cervical dysfunction.
- Have you had a recent spinal procedure?
Why: e.g. epidural, lumbar puncture or spinal anesthesia - may be cause of the headache, usually which come on when standing upright and relieved by lying down.
- Risk factors for benign intracranial hypertension?
Why: e.g. young, obese females, combined oral contraceptive pill, tetracycline, nitrofurantoin, Vitamin A preparations.
- Medications?
Why: e.g. monoamine (MAO) inhibitor antidepressants may cause headaches if the person also consumes foodstuffs containing tyramine such as cheese, yeast extracts, broad beans, cream, chocolate and alcohol; medications that may cause headache include non-steroidal anti-inflammatory drugs, corticosteroids, cyclosporine, oral contraceptive pill, calcium channel blockers, nitrates, theophylline, quinine, nitrazepam, ranitidine, beta-blockers, methyldopa, hydrallazine and dipyridamole. Some medications if taken regularly may cause rebound headache if you stop taking them such as aspirin, codeine and ergotamine. Benign intracranial hypertension may be linked with oral contraceptive pill, tetracycline, nitrofurantoin and Vitamin A preparations.
- Alcohol history?
Why: e.g. alcohol hangover or withdrawal may cause headache.
- Caffeine intake?
Why: including coffee, soft drinks and chocolate. Caffeine withdrawal may cause a headache.
- Family history?
Why: e.g. migraine, cluster headaches.
