Almost everyone at one time in their life has experienced a headache. Headache can arise primarily from the brain and related structures (muscle, blood vessel and nerves) in the head. A primary headache is when there is an increased activity of structures that are sensitive to pain in the head. When diseases outside the head activate the pain system and cause headache, it is called secondary headache. The most important thing that can help your doctor make a diagnosis of the cause of headache is the history you give during your visit. Appropriate history also helps to determine the type of test you need and treatment.  Since history is critical to diagnosis, this article will focus on what possible questions you need to know when dealing with headache. At other opportune time, we may go into individual causes of headache.

What do I need to know about history of headache?

Age it started: The age of onset of headache helps doctors to narrow down possible causes. While headache in a teenager may be related to tension, new onset headache above forty has different approach.

Does anyone in the family have same type of headache: Presence of family history of headache, is helpful in narrowing down causes.

When does it occur: the timing of the headache; is there any relationship to specific activity, or to work days. Headache that is present every morning needs to be looked into. If you have noticed it occurs about the same time every month or couple of months.

Where does it occur: location of headache is helpful with diagnosis. Headache in the temples in people over sixty years can be due to inflammation in the temporal arteries. In sinusitis, pain may be related to the location of the sinus.

What does it feel like when present: this is the quality of the pain? Is it achy, sharp, or shooting pain? Does it start from somewhere and they go to another place? How bad is the pain when it occurs? Does it feel the same way all the time or there has been a recent change compared to previous headaches. Change in pattern of headache warrants investigation. It is also equally important to know how long the headache last for when it occurs.

How does it occur: does the headache just start suddenly or it starts gradually?

Is there something that triggers the headache: Attention needs to be paid to factors that seem to happen prior to the headache, if any? Maybe you have noticed certain foods or activity bring on the headache. Headache can occur with alcohol hang over.

What do you do that takes the headache away: Does simple rest make it better? What if you avoided exposure to light? Migraine headaches tend to improve with rest and avoidance of light. Headaches that respond well to over the counter drugs may be tension headaches.

Did you have any trauma to the head: It does not matter whether it was blunt or sharp trauma? People can have delayed bleeding into tissues in the head after trauma. Every headache that starts after trauma requires investigation.

Any associated symptoms that occur either before, with or immediately after the headache: Vomiting can occur with migraine headaches, but it can also be a symptom of increased intracranial pressure. Some people have the feeling that the headache is coming on called an aura in migraine. Change in speech or alertness requires emergency care.

Do you use glasses: problems with vision are one of the common causes of headache.  Many people forget to let the doctor know that they wear glasses and have not checked them for a while.

Is there a change in strength: Any weakness of muscles in the setting of headache, can be impending stroke, call 911.

Are you taking any medications: Headache can be a side effect of some medications. Paradoxically, excessive use of pain killers to treat headache may also result in chronic headaches called rebound headache.  Do not forget over the counter medications, contraceptives in females.

Has headache caused death in the family: Death in a first degree relative during the course of headache requires quick investigation? People can die from aneurysm (ballooning of blood vessel) in the brain. Anyone who has direct relatives that have had this problem needs to be checked for aneurysm before they even develop headache.

Any recent travel: Some diseases that are not common in the US can present with headache. If you travelled out of the country, let the doctor know. Malaria and meningitis can present with headache. If you travel out of your state let the doctor know too. Diseases like Lyme disease can later develop after tick bite.

Do you have other medical conditions: Other ailment can affect the brain and present as headache.

Take home message

The better prepared you are with history regarding your headache, the easier it is for the doctor to narrow done causes and stepwise necessary investigation. Make your list ready when you are going for your visit. Do not assume headache is nothing, seek medical advice.

Dr Oluwatoyosi Dairo can be contacted at Amazing Medical Services PC at 110-16 Sutphin Blvd, Jamaica NY 11435 or on phone (718) 526 7600.

Disclaimer: This article is for educational purposes only and does not replace the advice of your doctor.

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