Head and neck, including regional lymphatics - What are the things to ask?

* Associated factors. Any relation to other symptoms: any nausea and vomiting? (Note which came first, headache or nausea.) Any vision changes, pain with bright lights, neck pain or stiffness, fever, weakness, moodiness, stomach problems?

Rationale: Nausea, vomiting and visual disturbances are associated with migraines; eye reddening and tearing, eyelid drooping, rhinorrhea, and nasal congestion are associated with cluster headaches; anxiety and stress are associated with tension headaches; nuchal rigidity and fever are associated with the headache of meningitis or encephalitis.

* Do you have any other illness?

Rationale: Hypertension, fever, hypothyroidism, and vasculitis produce headaches.

* Do you take any medications?

Rationale: oral contraceptive, bronchodilators, alcohol, nitrates, as well as carbon monoxide inhalation, produce headaches.

* What makes it worse: movement, coughing, straining, exercise?

* Pattern. Any family history of headache? What is the frequency of your headaches: once a week? Are your headaches occurring closer together? Are they getting worse? Or are they getting better? (for females) When do they our in relation to your menstrual periods?

Rationale: Migraines are associated with family history of migraine.

* Effort to treat. What seems to help: going to sleep, medications, positions, rubbing the area?

Rationale: With migraines, people lie down to feel better, whereas with cluster headaches they need to move – even to pace the floor – to feel better

* Coping strategies. How have these headaches affected your self-care, or your ability to function at work, home and socially?

2. Head injury. Any head injury or blow to your head?
* Onset. When? Please describe exactly what happened?
* Setting: any hazardous conditions? Were you wearing a helmet or hard hat?
* How about yourself just before injury: dizzy, lightheaded, had a blackout, had a seizure? Lose consciousness and then fall? (Not which came first). Knocked unconscious? Or did you fall and lose consciousness a few minutes later?
Rationale: Loss of consciousness before a fall may have a cardiovascular cause, e.g., heart block. A change in the level of consciousness is of prime importance in evaluating a neurologic deficit.


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