1. Headache. Any unusually frequent or unusually severe headaches?
* Onset. When did this kind of headache start?
* Gradual, over hours, or a day?
* Or, suddenly, over minutes, or less than 1 hour
* Ever had this kind of headache before?
Rationale: This is a more meaningful question that “Do you ever have headaches?” because most people have had at least one headache. Since many conditions have a headache as a symptom, a detailed history is important. A red flag is a severe headache in an adult of child who has never had it before.
* Location. Where do you feel it: frontal, temporal, behind your eyes, like a band around the head, in the sinus area, or in the occipital area?
Rationale: Tension headaches tend to be occipital or frontal or with bandlike tightness; migraines (vascular) tend to be supraorital, retroorbital, or frontotemporal; cluster headaches (vascular) produce pain around the eye, temple, forehead, and cheek.
* Is pain localized on one side, or all over?
Rationale: Unilateral or bilateral, e.g., with cluster headaches pain is always unilateral and always on the same side of the head.
* Character. Throbbing (pounding, shooting) or aching (viselike, constant pressure, dull)?
Rationale: Character is typically viselike with tension headache, throbbing with migraine or temporal arteritis.
* Is it mild, moderate or severe?
Rationale: Quantity is often severe with migraine, or excruciating with cluster headache.
* Course and duration. What time of day do the headaches occur: morning, evening, awaken you from sleep? How long do they last? Hours, days? Have you noted any daily headaches, or several within a time period?
Rationale Migraines occur about two per month, each lasting 1 to 3 days; one to two cluster headache occur per day, each lasting ½ to 2 hours for 1 or 2 months, then complete remission may last for months or years.
* Precipitating factors. What brings it on: activity or exercise, work environment, emotional upset, anxiety, alcohol? (Also note signs of depression)
Rationale: Alcohol ingestion and daytime napping typically precipitate cluster headaches, whereas alcohol, letdown after stress, menstruation and eating chocolate or cheese precipitate migraines.
