Structured headache history

What it is

A headache history is taken so that the type is named from its own features rather than from the pain alone. The items that separate the types are the site, the duration of one attack, the quality of the pain, what comes with it, what triggers it and what relieves it, and how often the attacks come. The same history also has to look for the red flags of a secondary headache.

How it presents

The types and the features that name them:

• Migraine. Unilateral throbbing headache, about 1 hour, with an aura lasting 15-30 minutes. Nausea and vomiting, photophobia and phonophobia go with it. The triggers are held in CHOCOLATE: chocolate, hangover, orgasms, cheese and caffeine, oral contraceptive, lie-ins, alcohol, travel, exercise.
• Tension. Bilateral pressing or tightening in quality, mild to moderate intensity, not associated with vomiting, does not prohibit activities and is not aggravated by physical activity. It is associated with stress and anxiety, and with functional or structural abnormalities of the head or neck; a family history of a similar headache is common. Episodic tension headache is defined as a headache lasting 30 minutes for seven days and occurring for less than 180 days a year. A patient may have years of daily headaches that worsen as the day progresses, with no prodrome, no nausea and no sensitivity to light or noise, and a normal neurologic examination.
• Cluster. An extremely painful headache focused around one eye, with autonomic symptoms on that side, listed as a dropping eyelid, a constructed pupil, a red watery eye, a runny or blocked nose and forehead sweating. It is more common in a smoker. The pain lasts 15 to 180 minutes and occurs from once every two days to eight times a day.
• Sinusitis. Frontal headache or facial pain, typically worse on movement or bending, with purulent nasal discharge or fever. It is an infection of a paranasal sinus, maxillary, frontal, ethmoid or sphenoid, and usually follows an upper respiratory infection or a tooth infection. It resolves spontaneously in 7-10 days.
• Trigeminal neuralgia. Paroxysms of intense stabbing, burning or electric shock type pain lasting seconds to minutes in the trigeminal nerve distribution, and 96% unilateral, mandibular and maxillary more than ophthalmic division. Between attacks there are no symptoms. The frequency ranges from hundreds a day to a remission lasting a year. The pain may be provoked by movement of the face, by talking, eating or laughing, or by touching the skin while shaving or washing.