Archive:Headache assessment: Difference between revisions
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HPI | ==HPI== | ||
*FIRST or WORST headache ever? | *FIRST or WORST headache ever? | ||
*DIFFERENT from usual headaches? | *DIFFERENT from usual headaches? | ||
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**confusion | **confusion | ||
=='''RED FLAGS OF SERIOUS HEADACHES'''== | |||
===New onset=== | |||
*headaches beginning at age 40 | *headaches beginning at age 40 | ||
**mass lesion, temporal arteritis | **mass lesion, temporal arteritis | ||
===More SEVERE and FREQUENT headaches (worst headache ever)=== | |||
*mass lesion, subdural hematoma, medication overuse | *mass lesion, subdural hematoma, medication overuse | ||
===SUDDEN onset (maximal at onset - no increase over time)=== | |||
*SAH, mass lesion (especially in the posterior fossa) | *SAH, mass lesion (especially in the posterior fossa) | ||
*new onset in patient with risk factors for HIV or CANCER | *new onset in patient with risk factors for HIV or CANCER | ||
**meningitis, brain abscess, metastasis | **meningitis, brain abscess, metastasis | ||
===headache ASSOCIATED with=== | |||
*fever (meningitis, encephalitis, systemic infection) | *fever (meningitis, encephalitis, systemic infection) | ||
*projectile vomiting | *projectile vomiting | ||
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*trauma (intracranial hemorrhage, subdural/epidural hematoma, SAH) | *trauma (intracranial hemorrhage, subdural/epidural hematoma, SAH) | ||
PMHx | ==PMHx== | ||
*hypertension | *hypertension | ||
*HIV | *HIV | ||
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*recent procedures | *recent procedures | ||
==Medication== | |||
Family history | ==Family history== | ||
{{OSCE2}} | {{OSCE2}} | ||
[[Category:Medicine]][[Category:OSCE]] | [[Category:Medicine]][[Category:OSCE]] | ||
Revision as of 00:58, 18 May 2007
HPI
- FIRST or WORST headache ever?
- DIFFERENT from usual headaches?
- Onset = when did it start?
- gradual, sudden (thunder-clap)
- Palliation/Provokative
- stress, food, menstrual cycle, rest
- Quality
- unilateral, bilateral, band-like?
- does it spread?
- throbbing, stabbing, dull, pressure
- Radiation
- where does it spread?
- Severity
- Nausea/vomiting
- photo/phonophobia
- vision changes
- fever
- stiff neck
- confusion
RED FLAGS OF SERIOUS HEADACHES
New onset
- headaches beginning at age 40
- mass lesion, temporal arteritis
More SEVERE and FREQUENT headaches (worst headache ever)
- mass lesion, subdural hematoma, medication overuse
SUDDEN onset (maximal at onset - no increase over time)
- SAH, mass lesion (especially in the posterior fossa)
- new onset in patient with risk factors for HIV or CANCER
- meningitis, brain abscess, metastasis
headache ASSOCIATED with
- fever (meningitis, encephalitis, systemic infection)
- projectile vomiting
- impaired mental status
- focal neurological signs - weakness, paresthesia (mass lesion, stroke)
- recent head injury
- papilledema (mass lesion, pseudotumor, meningitis)
- meningismus (meningeal irritation)
- seizures
- trauma (intracranial hemorrhage, subdural/epidural hematoma, SAH)
PMHx
- hypertension
- HIV
- cancer
- trauma
- recent procedures
Medication
Family history
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence