geekymedics.com/headache-history-taking
HPC
Past Medical Hx
Drug Hx
Family Hx
Social Hx
Systemic enquiry
Interactive mark scheme
Mark Scheme (PDF)
Gain consent
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Ensure the patient is comfortable
Presenting complaint
It’s important to use open questioning to elicit the patient’s presenting complaint
Allow the patient time to answer, trying not to interrupt or direct the conversation.
“Ok, so tell me more about that” “Can you explain what that pain was like?”
Onset:
Radiation – neck (meningitis) / face (e.g. trigeminal neuralgia) / eye (e.g. acute closed
angle glaucoma)
Associated symptoms:
Duration of headache?
Is it episodic?
Any clear pattern?
Diurnal variation?
Chronic headaches – in a month of 30 days, for how many of those days would the
patient have a headache?
Exacerbating/relieving factors:
Exacerbating factors – are there any obvious triggers for the symptom?
(e.g. caffeine / codeine / stress / postural change)
Relieving factors – does anything appear to improve the symptoms (e.g.
improvement upon lying flat suggestive of reduced ICP).
Severity:
Red flags
Red flags within a headache history are many and varied, so familiarise yourself with
common patterns.
Concerns – explore any worries the patient may have regarding their symptoms
Expectations – gain an understanding of what the patient is hoping to achieve from the
consultation
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Summarising
Summarise what the patient has told you about their presenting complaint.
This allows you to check your understanding regarding everything the patient has told
you.
It also allows the patient to correct any inaccurate information and expand further on
certain aspects.
Once you have summarised, ask the patient if there’s anything else that
you’ve overlooked.
Continue to periodically summarise as you move through the rest of the history.
Signposting
Signposting involves explaining to the patient:
What you have covered – “Ok, so we’ve talked about your symptoms and your
concerns regarding them”
What you plan to cover next – “Now I’d like to discuss your past medical history and
your medications”
History of malignancy?
Previous surgery? – e.g. CSF shunting (blocked/infected shunts present with headache)
Drug history
Regular prescribed medication?
Family history
Neurological diagnoses in first degree relatives? – e.g. migraine
Social history
Smoking – How many cigarettes a day? How long have they smoked for?
Alcohol – How many units a week? – be specific about type / volume / strength of alcohol
Living situation:
Systemic enquiry
Systemic enquiry involves performing a brief screen for symptoms in other body systems.
This may pick up on symptoms the patient failed to mention in the presenting complaint.
Some of these symptoms may be relevant to the diagnosis (e.g. neck stiffness in
meningitis).
Choosing which symptoms to ask about depends on the presenting complaint and your
level of experience.
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Urinary – Volume of urine passed / Frequency / Dysuria / Urgency / Incontinence
Summarise history
Assessment
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6/6