Introduction & Setup

• Greet and Introduce:
  “Hello, I’m Dr. [Your Name]. I will be asking you some questions about your headache to understand it better.”
• Confirm Identity:
  “Can I confirm your name and age, please?”
• Consent:
  “Is it okay if I ask you some questions about your headache?”
• Ensure privacy and comfort

S – Site

• Purpose: Localizing pain narrows down possible causes.
• Sample question:
  “Where exactly do you feel the headache? Is it on one side or both?”
• Notes:
  • Unilateral: migraine, cluster headache
  • Bilateral: tension headache, raised ICP
  • Occipital: cervical causes, posterior fossa lesion
• Red flags: Pain focused behind the eyes or temples (temporal arteritis)

O – Onset

• Purpose: Helps differentiate acute vs chronic or emergency conditions.
• Sample questions:
  “When did your headache start?”
  “Was it sudden or gradual?”
• Notes:
  • Sudden (“thunderclap”): subarachnoid hemorrhage, stroke
  • Gradual: tumor, tension headache
• Red flags: Sudden onset severe headache requires urgent evaluation.

C – Character

• Purpose: Nature of pain suggests diagnosis.
• Sample question:
  “Can you describe the type of pain? Is it sharp, dull, throbbing, pressure-like?”
• Notes:
  • Throbbing: migraine
  • Dull/pressure: tension headache
  • Sharp/stabbing: cluster headache, neuralgia
• Red flags: Severe, different character than usual headache

R – Radiation

• Purpose: Spread of pain can guide localization.
• Sample question:
  “Does the pain move anywhere, like to your neck, shoulders, or behind the eyes?”
• Notes:
  • Radiation to neck: cervical spine issues
  • Radiation to behind eyes: cluster headache, sinusitis

A – Associations & Aggravating/Relieving Factors

• Purpose: Associated symptoms and triggers guide diagnosis and urgency.
• Sample questions:
  “Do you have any other symptoms with the headache like nausea, vomiting, fever, neck stiffness, or visual problems?”
  “What makes the headache worse or better?”
• Notes:
  • Nausea/vomiting: migraine, raised ICP
  • Fever, neck stiffness: meningitis, abscess
  • Visual changes: raised ICP, temporal arteritis
  • Worse with bending/coughing: raised ICP, sinusitis
• Red flags: Vomiting, fever, neck stiffness, visual loss, neurological deficits

T – Timing

• Purpose: Duration and frequency provide diagnostic clues.
• Sample questions:
  “How long does each headache last?”
  “How often do they occur?”
  “Are they constant or intermittent?”
• Notes:
  • Constant progressive headache: tumor, hydrocephalus
  • Episodic lasting hours: migraine
  • Cluster: brief episodes multiple times a day

E – Exacerbating & Relieving Factors

• Purpose: Understand triggers and what helps.
• Sample questions:
  “Does anything make the headache worse, like movement or light?”
  “Does anything help relieve it, such as rest or medication?”
• Notes:
  • Worsened by light/noise: migraine
  • Worsened by bending forward: sinusitis
  • Relieved by rest or medications: tension/migraine

S – Severity

• Purpose: Gauge impact and urgency.
• Sample questions:
  “On a scale of 1 to 10, how bad is your headache?”
  “Has it gotten worse over time?”
• Notes:
  • Severe or rapidly worsening requires urgent action
  • Mild/moderate chronic headache less urgent but needs evaluation

Additional History Components

• Past medical/surgical history:
  “Have you had any previous illnesses, head injuries, or surgeries?”
• Medication history:
  “Are you taking any medicines, especially blood thinners or painkillers?”
• Family history:
  “Does anyone in your family have headaches or neurological diseases?”
• Social history:
  “Do you use tobacco, alcohol, or recreational drugs?”
  “What is your daily stress level or sleep pattern?”

Red Flags to Always Watch For

• Sudden, severe “worst-ever” headache
• New neurological deficits (weakness, numbness, vision changes)
• Fever, neck stiffness (meningitis)
• Vomiting, especially projectile
• Altered consciousness or seizures
• Headache after trauma
• Immunocompromised patient or cancer history

Communication & Empathy Tips

• Use simple language and be patient
• Show empathy: “I understand this is worrying for you”
• Reassure about investigations: “We will do tests to find the cause”
• Involve patient in decisions
• Maintain good eye contact and open body language

Summary & Closing

• Summarize main points:
  “So, your headache started [onset], is located [site], and feels [character]. You also have [associated symptoms]. Is that correct?”
• Ask if patient wants to add anything else
• Thank the patient for cooperation