Headache
In a headache workup, gather and document onset and pattern, associated features, analgesic use, blood pressure and a neurological examination, and the red flags for a secondary cause.
Head and nervous system: In these presentations, the history and a focused neurological examination carry most of the weight.
Key takeaways
- Record how quickly the headache reached its peak.
- Count the days per month the patient takes pain relievers.
- Document the red flags for a secondary headache, present or absent.
What this presentation is
Most headaches are primary, such as migraine and tension-type headache. The workup looks for the features that suggest a secondary cause.
A headache diary and a count of analgesic days help separate a primary headache from medication overuse.
Gather these sources first
- The referral and previous neurology letters
- Any brain imaging reports
- Blood pressure readings over time
- A headache diary if the patient keeps one
- Inflammatory markers when giant cell arteritis is considered
- The medication list, including over-the-counter analgesics
Document these history questions
- Onset, and how quickly the pain reached its peak
- Pattern over weeks and months, and any change
- Site, character and duration of attacks
- Aura, nausea, photophobia and phonophobia
- Triggers, including posture, coughing and straining
- Analgesic use in days per month
- Impact on work, sleep and daily life
Record these findings
- Blood pressure and temperature
- Neurological examination, including cranial nerves
- Funduscopy findings
- Temporal artery tenderness in older patients
- Neck stiffness when infection is considered
Ask about these red flags
Record each one as present or absent. Your local pathway decides what happens when one is present.
- Sudden severe headache reaching its peak within a minute
- New headache in an older adult
- Fever with neck stiffness or rash
- New neurological deficit or papilledema
- Headache worse on lying down, coughing or straining
- Jaw claudication or scalp tenderness
- History of cancer or immunosuppression
- Headache in pregnancy or after giving birth
Put these in the assessment draft
- A description of the headache pattern
- Primary or secondary, with the reasoning
- The red flags asked about and the answers
- Analgesic use and any concern about overuse
- A plan with investigations, referral and safety-netting advice
How Workup Desk helps
Add the diary, the imaging reports and earlier letters to the workspace. Ask how the pattern described in the letters has changed.
Draft the assessment with the red flags listed and edit it. Check each answer against its source to see what was asked before.
Frequently asked questions
Why count analgesic days rather than doses?
Medication overuse headache relates to how many days a month pain relievers are taken. Days per month is the number a reader can compare.
General guidance on what to gather and document, not advice about any individual patient. Local guidelines and your clinical judgment govern.