Think about the symptoms that Sadie has and what type of headache she is likely to have.
3 points when assessing headache;
History taking – things to think about.
Q Why is Sadie consulting now?
A. Her father’s best friend has just died from a brain tumour.
Q What concerns does Sadie have about this headache?
A. Although an underlying brain tumour is rare, it is invariably a concern for both patient and practitioner.
Q How many types of headache does Sadie have?
A. Often people will present with a number of different types. If one type is migraine, the others are likely to be part of a migraine spectrum.
Q Is the headache progressive?
A. A worsening headache can mean that there is something to be concerned about.
Q Ask Sadie about how this affects her day to day life?
A. She is missing social events and having to have time off work.
Q Is there a family history?
A. Migraines can run in families.
Q Ask Sadie what she does when she has the headache, this can give a clue as to the type. People with migraine will want to lie in a dark quiet room, people with cluster headache will pace the room and be agitated, tension-type headache will have little influence on activity.
A. Sadie likes to lie in a dark room and wear sunglasses or a peaked cap if in the daylight.
What has she taken to help the pain and when? Exclude medication overuse headache. This will occur if over a three-month period or longer the patient is taking analgesics on 15 days a month or triptans on more than 10 days.