Medical history (history of illness) is an important component in the diagnosis of cephalgia (headache). Family history
- What is the general health of your relatives?
- Are there any diseases in your family that are common?
- Are there any hereditary diseases in your family?
Social history
- What is your profession?
- Are you exposed to harmful working substances in your profession?
- Is there any evidence of psychosocial stress or strain due to your family situation?
- Do you have a lot of stress?
- Are you exposed to noise?
Current anamnesis/systemic anamnesis (somatic and psychological complaints).
Current medical history/systemic anamnesis (somatic and psychological complaints).
- How does the headache begin?
- Acute (occurring suddenly)?
- Subacute (“moderately rapid”)?
- Insidious?
- Occurrence of the headache
- First event
- Attack-like
- Episodic/recurrent/periodic
- Chronic/known for a long time
- Trigger factors (triggers: see below).
- How severe are the headaches? (Pain intensity)
- Is the headache stabbing or dull? (pain character)
- Where is the headache localized?
- Unilateral?
- Double-sided?
- Frontal (e.g., forehead headache)?
- Occipital (“towards the occiput”)?
- Orbital (eye socket)?
- Does the pain radiate?
- Does the headache become more intense:
- With movement?
- During heavy exertion?
- How long does the headache last? (Attack duration)
- Seconds/hours/days/weeks
- How often do the headaches occur? (Attack frequency)
- Continuous?
- Continuously increasing?
- Periodic recurrence?
- Irregular but recurring?
- Number of headache attacks per month? ; How many months has this been happening?
- Trigger factors (triggers)?
- Weather influences (e.g. temperature).
- Sleep: headaches at night?
- Stress
- Menstruation
- Diseases (anemia/poor blood; hypertension/high blood pressure).
- Season
- On a scale of 1 to 10, where 1 is very mild and 10 is very severe, how severe is the pain?
- Do you have any accompanying symptoms/circumstances?
- Visual disturbances (flicker scotoma)? If yes, what is the nature of the visual disturbances? [due toe.g. glaucoma (acute attacks), arteritis temporalis (amaurosis fugax), acute posterior infarction (acute hemiparesis headache with hemianopsia), intracranial pressure elevation]
- Nausea, vomiting, light and noise aversion?
- Eye tearing, ptosis (complete or even partial drooping of one or both upper eyelids), runny nose (trigeminiform symptoms)?
- Speech disorders? *
- Paralysis or sensory disturbances? *
- Are you restless during the headache attack?
- Do you need to lie down during the headache attack?
- Do you have non-restorative sleep, pauses in breathing, snoring?
- Do you have a fever?
- Does awakening occur because of a headache at night?
- What measures, behaviors or medications lead to a decrease in headache intensity?
Vegetative anamnesis including nutritional anamnesis.
- Are you overweight? Have they lost weight? Please tell us your body weight (in kg) and height (in cm).
- Do they like to drink coffee, black and green tea? If so, how many cups per day?
- Do you drink other or additional caffeinated beverages? If so, how much of each?
- Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
- Do you drink alcohol? If yes, what drink(s) and how many glasses of it per day?
- Do you use drugs? If yes, what drugs and how often per day or per week?
- Do you eat regularly and in a balanced way?
- Do you like to eat cheese, chocolate, etc.?
- Do you sleep regularly?
- Did you previously have sports with heavy exertion?
- Do you spend time at high altitude more regularly?
Self history including medication history.
- Pre-existing conditions of any kind (including accidents): known primary headache syndrome, cardiovascular disease (heart and vascular disease)/risk (hypertension/high blood pressure), malignancy (cancer), anemia (anemia), autoimmune disease.
- Successful therapies:
- Has an attempt been made to interrupt a continuous headache using corticosteroid shock therapy?
- Has an indomethacin test been performed?
- Operations
- Radiotherapy
- Vaccination status
- Allergies
- Pregnancies
- Environmental history
Medication history
- Acetylcholinesterase inhibitors (donezepil, galantamine, rivastigmine).
- Alpha-adrenoreceptor antagonists or alpha-blockers (alfuzosin, tamsulosin).
- Analgesics
- Non-opioid analgesics (flupirtine).
- Nonacid analgesics (NSAIDs) (acetylsalicylic acid (ASA), coxibe, diclofenac, ibuprofen, indometacin, meloxicam, naproxen, acetaminophen/paracetamol)
- Opioids (alfentanil, buprenorphine, dextropoxyphene, diamorphine (heroin) fentanyl, hydromorphone, levomethadone, meptazinol, morphine, nalbuphine, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tilidine, tramadol).
- Antiarrhythmics
- Adenosine, Ia antiarrhythmics (ajmaline).
- Ic antiarrhythmics (flecainide, propafenone).
- Class II antiarrhythmics (esmolol, metoprolol).
- Class IV antiarrhythmic drugs (diltiazem, verapamil).
- Anthelmintics (albendazole, diethylcarbamazine).
- Antibiotics
- Quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin).
- Derivative of rifamycin (rifaximin).
- Epoxide antibiotics (fosfomycin trometamol).
- Macrolides (azithromycin, clarithromycin, erythromycin).
- Nitroimidazoles (metronidazole).
- Oxazolidinones (linezolid)
- Rifampicin
- Sulfone (dapsone)
- Anticholinergics (ipratropium bromide).
- Antiepileptic drugs
- Carboxamide derivatives (eslicarbazepine acetate).
- Functionalized amino acids (lacosamide).
- Classical antiepileptic drugs (gabapentin, topiramate).
- Antihistamines (cetirizine, clemastine, dimetindene, ketotifen).
- Antimalarials (artemether, atovaquone, quinine, chloroquine, dihydroartemisinin, lumefantrine, primaquine, proguanil).
- Antifungals, systemic
- Azoles (griseofulvin)
- Antipsychotics (neuroleptics) – melperone, risperidone.
- Antirheumatic drugs, non-steroidal – acetylsalicylic acid (ASA), diclofenac, ibuprofen.
- Antisympathotonic (clonidine, urapidil).
- Antitussive
- Non-opioid antitussives (levodropropizine, noscapine, pentoxyverine).
- Antivertiginosa (betahistine).
- Anxiolytics (hydroxyzine)
- Α2-agonists (apraclonidine, brimonidine, clonidine).
- Barbiturates (pentobarbital, phenobarbital, primidone, thiopental).
- Benzodiazepine-like substances (buspirone).
- Beta-blockers
- Nonselective beta-blockers (e.g., carvedilol, pindolol, propranolol, soltalol).
- Selective beta blockers (e.g., atenolol, acebutolol, betaxolol, bisoprolol, celiprolol, nebivolol, metoprolol).
- Beta-blockers, eye drops – betaxolol, timolol.
- Betamimetics (synonyms: β2-sympathomimetics, also β2-adrenoceptor agonists) – fenoterol, formoterol, hexoprenaline, ritodrine, salbutamol, salmeterol, terbutaline.
- Calcium antagonists (amlodipine, diltiazem, felodipine, fendiline, gallopamil, lacidipine, lercanidipine, nitrendipine, nifedipine, nimodipine, nicardipine, isradipine, nisoldipine, nilvadipine, manidipine, verapamil).
- Calcium channel blockers
- Benzothiazepines (diltiazem)
- Dihydropyridines (amlodipine, felodipine, isradipine, lercandipine, nicardipine, nilvadipine, nisoldipine, nitrendipine)
- Phenylalkylamine (verapamil)
- Calcium sensitizer (levosimendan).
- Chelating agents (deferoxamine, deferasirox, deferiprone).
- Chloride channel activator (lubiprostone).
- Cholinergics (carbachol, physostigmine, pilocarpine).
- Direct factor Xa inhibitor – rivaroxaban.
- Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors; gliptins) – saxagliptin, sitagliptin, vildagliptin
- Dopamine agonists (cabergoline, bromocriptine).
- Endothelin receptor antagonists (endothelin receptor antagonists) – ambrisentan, bosentan.
- Cardiac glycosides (digoxin, digitoxin, ß-acetyldigoxin, ß-methyldigoxin).
- Hormones
- ADH analogues – desmopressin
- Anti-androgens (cyproterone acetate, flutamide).
- Aromatase inhibitors (anastrozole, testolactone).
- Progestins (dyhrogesterone)
- Gonadotropins (FSH. LH)
- GnRH analogues (buserelin, buderelin acetate, goserelin, goserelin acetate, leuprorelin, leuporelin acetate, nafarelin acetate, triptorelin, triptorelin acetate).
- GnRH antagonists (abarelix, cetrorelix, degarelix).
- Contraceptives (estrogen-progestin combination).
- LHRH agonists (goserelin)
- LHRH analogues
- Estrogens
- Parathyroid hormone analogue (teriparatide)
- Progesterone receptor antagonist (mifepristone).
- Prostaglandin analogues (alprostadil/prostaglandin E).
- Prostanoids (prostacyclins) – epoprostenol, iloprost, treprostinil.
- Somatotropic hormone (STH) – growth hormones (somatotropin; growth hormone (GH).
- Immunosuppressants (azathioprine, ciclosporin (cyclosporin A), methotrexate (MTX))
- Immunotherapeutics (fingolimod, mitoxantrone, natalizumab).
- Local carbonic anhydrase inhibitors (brinzolamide, dorzolamide).
- Lipid-lowering agents
- Cholesterol absorption inhibitor – ezetimibe
- HMG-CoA reductase inhibitors (statins) – atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin
- MAO inhibitors (tranylcypromine).
- Monoclonal antibodies – pertuzumab, trastuzumab.
- MTOR inhibitors (everolimus, temsirolimus).
- Multi-tyrosine kinase inhibitor (vandetanib).
- Mucolytics (acetylcysteine (ACC), N-acetylcysteine (NAC); N-acetyl-L-cysteine).
- Muscle relaxants (baclofen, tizanidine).
- Ergot alkaloids (ergotamines)
- Neurokinin antagonists (aprepitant, fosaprepitant).
- Nicotinic antagonist (varenicline).
- N-methyl-D-aspartate recptor antagonist (Memantine).
- Nitrates (glycerol nitrate, glycerol trinitrate, isosorbide dinitrate, isosorbide 5-mononitrate, molsidomine, nitroglycerin, nitroprusside sodium).
- Opioid receptor antagonist (loperamide, naltrexone).
- Parasympathomimetics
- Indirect parasympathomimetics (cholinesterase inhibitors): alkylphosphates, distigmine, donepezil, galantamine, neostigmine, physostigmine, pyridostigmine, rivastigmine, tacrine
- Phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil).
- Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
- Psychotropic substances such as modafinil.
- Retinoids (acitretin, alitretinoin)
- Rheologics (pentoxifylline)
- Selective dopamine and norepinephrine reuptake inhibitor (NDRI) – bupropion.
- Serotonin antagonists (dolasetron, granisetron, ondansetron, tropisetron).
- Sinus node inhibitor (ivabradine).
- Spasmolytics (tolterodine, trospium chloride).
- Stronitum salt (strontium ranelate).
- Sympathomimetics
- Tranquilizers
- Triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan).
- Tyrosine kinase inhibitors (vandetanib).
- Uricosurics (benzbromarone, probenecid).
- Vasoactive substances – alprostadil (prostaglandin E), dihydralazine, vasopressin, diazoxide.
- Antivirals
- Nucleos(t)idic polymerase (NS5B) inhibitors (sofosbuvir).
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – didanosine, efavirenz, nevirapine, rilpivirine.
- NS5A inhibitors (daclatasvir, ledipasvir,
- Nucleoside analogues (abacavir, aciclovir, brivudine, famciclovir, foscarnet, ganciclovir, ribavirin, telbivudine, valaciclovir.
- Nucleotide analogues (adefovir, tenofovir).
- Nucleoside reverse transcriptase inhibitors (NRTI) – entecavir, lamivudine, stavudine, zidovudine.
- Protease inhibitors (PI; protease inhibitors) – atazanavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir.
- Bismuth (bismuth nitrate, bismuth subcitrate, bismuth subsalicylate).
- Cytokines (glatiramer acetate, interferon ß-1a, interferon ß-1b).
- Cytoreductive drugs (anagrelide).
- Cytostatic drugs (methotrexate (MTX))
Further
- Keeping a headache diary