Headache (Cephalgia): Medical History

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)?
  • 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

Further

  • Keeping a headache diary