Headache is a common presenting complaint and certainly something you’ll encounter many times over your career. The vast majority of headaches are not life-threatening, with tension headache and migraine being the most common diagnoses. Headache is however also associated with a number of serious conditions and therefore it is essential you are able to take a comprehensive headache history and identify red flags that indicate the need for further investigation.
It’s important to use open questioning to elicit the patient’s presenting complaint
“So what’s brought you in today?” or“Tell me about your headache”
Allow the patient time to answer, trying not to interrupt or direct the conversation.
Facilitate the patient to expand on their presenting complaint if required.
“Ok, so tell me more about that” “Can you explain what that pain was like?”
History of presenting complaint
The aim now is to encourage the patient to give further details about their complaint to allow you to narrow the differential diagnosis. One useful way to gain further details about a headache is to use the SOCRATES system of questions as shown below.