This is an excerpt from my history taking, assessment, and diagnosis field guide.
HEADACHE:
New?: -Is this the first time the patient has ever felt this kind of headache?
Onset: -How long ago did the headache begin? -Was it a sudden onset at maximal intensity, or has it gradually gotten worse over time?
Provocation/Palliation:
-What was the patient doing prior to the start of the headache?
-Does anything seem to make the symptoms worse? Does anything alleviate them?
-Has the patient taken anything for the pain?
Quality: -What does the pain feel like?
Radiation: -Is the pain just in one spot or does it radiate across the head or to any other areas such as the neck or face?
Severity: -On a 0-10 scale, how bad is the pain? -Has this pain level been constant or does it fluctuate?
Time: -Is the pain constant or intermittent?
Ask about associated symptoms including:
-Dizziness/weakness
-Unsteady gait
-Neck pain or stiffness
-Photosensitivity
-Recent fever or chills
-Visual disturbances/ or auditory disturbances
-Prior cardiac history/CVA history/HTN
-Nosebleeds
-Paresthesia in the extremities
-Is the pain worse at certain times, does lying flat or standing up make it worsened
Differential includes:
-CVA: “Thunderclap headache” maximal intensity, visual disturbances, weakness, alterations in LOA, Possible syncope.
-Migraine: Unilateral pain that gradually moves across the head, photosensitivity, nausea, usually has a visual aura during prodrome, typically patient has a history.
-Meningitis: Fever, nuchal rigidity, nausea, altered LOA, petichae rash on body, typically prior infection.
-Symptomatic hypertension: Dizziness, nausea, visual or auditory disturbances, vertigo, unsteady gait, epistaxis.
-Hypoglycemia: Altered LOA, hunger, thirst, nausea, diaphoresis, drowsiness, irritability.
Assessments: -FAST Stroke exam
-Vitals, including BGL
-Visual fields test, looking for visual disturbances or nystagmus
-12-lead ECG if the patient is altered or sepsis is suspected.
Treatment options:
-Maintain ABCs
-Obtain vascular access
-Treat for nausea
-Treat for hypoglycemia
-If CVA is suspected, transport to appropriate facility
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