Taking the Headache History From Location to Neurological Symptoms

The history should end with a working diagnosis. Patients can have more than one headache type, and a new, sinister headache can be mistaken for part of an old migraine. For each type, ask about location, side shift, intensity, quality and frequency, whether there is a headache between exacerbations, and whether it lasts more or less than four hours. Premonitory symptoms such as yawning, food cravings or neck pain can make a migraine look like a neck problem. For unilateral headache, ask about autonomic signs and whether the patient wants to pace or lie down in a dark room. Focal neurological symptoms point to the brainstem, the cerebellum or ischemia of the eye and need urgent attention. In anyone over fifty with new, escalating headache and jaw claudication, assume giant cell arteritis until proven otherwise; it is linked with polymyalgia rheumatica and needs prompt corticosteroids. Migraine is comorbid with neck and jaw pain, irritable bowel syndrome, fibromyalgia and anxiety. About half of migraineurs keep childhood motion sickness, and they are three times more likely to get BPPV.