These are all great questions
Ok so what should we ask ourselves and/or the patietn...
Immediate questions that should come to our mind1) Has this patient experienced similar headaches before?
If the headache is similar to previous tension or migraine headache then the situation is unlikely to be urgent. However, if the headache is new or deviates from a previous pattern, several potentially serious conditions should be considered., including acute glaucoma, sinusitis, subarachnoid hemorrhage, meningitis, neoplasm and early hyptertensive encephalopathy.2)What are the patient's vital signs?
Although essential hypertension by itself is an infrequent causes of headache, it may exacerbate preexisting vascular or tension headache. Diastolic blood pressure >140 mm Hgcan cause severe headache. A fever
should alert you to the possibility of subarachnoid hemorrhage, meningitis, temporal arteritis or acute sinusitis
3)Is the patient taking any anticoagulants?
Is there a predisposition to bleeding? Aspirin and warfarin increase the risk of an intracranial hemorrhage, especially with minor head trauma. Spontaneous intracranial bleeding occurs with platelet counts of less than 20,000.
Location, radiation, severity, alleviating, exacerbating factors?
How often does the patient get headaches?
How long does a typical headache last?
Any pattern to the headaches?
In females, does she notice a relationship between headache and menstrual cycles.
Anything precipitates the headache>
Is the patient under stress?
Any trouble sleeping?
Recent nausea, vomiting, photophobia or visual changes?
Any dizziness? drowsiness? confusion?
Recent seizures? History of seizures?
A detailed well focused history is the most important tool for evaluating headache. The great majority of headaches are secondary to either tension-type or migraine headaches. a headachemay also be the only symptom of a more serious condition such as an intracranial mass, temporal arteritis, meningitis and subarachnoid hemorrhage.(A) TENSION HEADACHE1- Episodic tension-type headache.
This is frequently described as a squeezing, "band like" tightness that is usually felt bilaterally. IT may occur in the occipital, frontal or bitemporal regions. Occasionally, patients with tension-type headache may describe a " throbbing" pain. This form of headache may last minutes to days; it is generally described as having a mild to moderate intensity.
2-Chronic tension-type headache.
This headache is similar to the acute tension-type in quality but its duration may be months to even years. Depression, personality problems, and a history of narcotic abuse are common in these patients.(B) MIGRAINE HEADACHES
Although the precise pathophysiology has not been full ascertained , it is though to be secondary to cerebral vasoconstriction followed by vasodilation. The initial vasoconstriction may be associated with a variety of neurological deficits including visual disturbances( scotomas, zig-zag lines, bright lights), dysarthria, hemiparesis and hemianestheisa. Of these, the visual phenomena are most common. These neurologic features generally last 5-30 mins and are then followed by headache. The headache is usually pounding or throbbing but may be dull and boring. It is usually unilateral but may all occur bilaterally in any location.
The attack my last several hours to 2-3 days and occasionally longer. Migraines are much more common in women. Three characteristic migraine patterns are recognized: 1-Migraine without aura ( common migraine)
This vascular headache is not preceded by neurologic deficits or visual disturbances. It is the most comon type, especially in women.2- Migraine with aura ( classic migraine)
THe headache is preceded by visual deficits such as scotomas and field deficits, but can affect somatic sensation, speech and motor function.3-Complicated migraine.
The headache is accompanied by neurological symptoms including hemiplegia and ophthalmoplegia.(C) CLUSTER HEADACHES
Cluster headaches are excruciating, usually unilateral and frequently associated with ipsilateral nasal congestion, lacrimation, and conjunctival injection. Nausae, vomiting, photophobia typically lasts < 2 hours; however, multiple attacks can occur within 24 hour period.
Onset shortly after falling asleep is common. Unlike migraines, cluster headaches most often affect men between the agres of 20 and 40 . They are not familial.(D)TEMPORAL ARTERITIS
Temporal arteritis should be considered in any patient older than 50 years presenting with a recent history of headache. Other symptoms such as malaise, weight loss, fever and myalgias are frequenlty present. Jaw claudication is a classic symptom. It is especially important to ask about any new visual problems such as double or blurred vision. Temporal arteritis can cause sudden blindness as a result of infammation of the ophthalmic artery. Early diagnosis and treatment with steroids are necessary to prevent this complication.
This condition is more common in the elderly. The pain is described as brief, but severeand jabbing. The pain is usually unilateral and localized to one or more division of the trigeminal nerve. Precipitants including talking, chewing, or having physical pressure exerted on a specific trigger area. Etiology is unknown.