Headache/ Funny Turn (Blackout)
Take a history of a patient presenting with headaches, focussing on the patient's
concerns. Was a typical tension headache and the patient was worried he would
Student Reports on Finals 2011: Aberdeen
www.askdoctorclarke.com 3
have to go for a brain scan - station was just about reassuring this wasn't necessary,
and delve into the fact that his job was stressful to him too.
1) Appropriate introduction (full name and role)
2) Common causes of headache: tension headache, cluster headache, migraine, cranial
arteritis, cervical spondylosis, intracranial mass lesion e.g. tumour, meningeal irritation, SAH
3) Explains purpose of interview
4) Establishes onset of symptoms and duration
5) SAH- Sensitive to the fact that patient is in severe distress and comment on need of
analgesia and antiemetic
6) Ask specifically about
a. SOCRATES
b. Associated factors: nausea, vomiting, visual disturbances (aura, double vision,
fortification spectra) photophobia, fevers or chills, weight loss, rash, tender
temporal artery, neck pain or stiffness, myalgia, rhinorrhea or lacrimation, altered
level of consciousness, neurological deficit
c. Timing
d. Exacerbating and relieving factors: activity, caffeine, alcohol, dehydration, stress,
eye strain, coughing or sneezing, bright lights, menses, hunger, certain foods
e. Severity- effect on the patients life
7) Establishes characteristic of headache :
a. Site
b. Radiation
c. Duration
d. Nature/severity
e. Relieving factors
f. Exacerbating factors
g. Precipitating factors
8) Establishes associated symptoms:
a. Meningism
b. Nausea and vomiting
c. Warning aura
d. Visual disturbances, blurring of vision
e. Weakness (in myasthenia gravis characteristic weakness increases with fatigue) and
tingling, excludes sensory symptoms- paraesthesia and numbness
9) SAH- neck stiffness, nausea, vomiting, mild photophobia, sudden onset headache- worst
ever, excludes fever and symptoms of upper and lower respiratory tract infection.
Establishes FHX of cerebro-vascular and renal disease, excludes previous history of
headaches specifically migraine.
10) Multiple Sclerosis- establishes retro-orbital pain and visual loss
Take a history of a patient presenting with headaches, focussing on the patient's
concerns. Was a typical tension headache and the patient was worried he would
Student Reports on Finals 2011: Aberdeen
www.askdoctorclarke.com 3
have to go for a brain scan - station was just about reassuring this wasn't necessary,
and delve into the fact that his job was stressful to him too.
1) Appropriate introduction (full name and role)
2) Common causes of headache: tension headache, cluster headache, migraine, cranial
arteritis, cervical spondylosis, intracranial mass lesion e.g. tumour, meningeal irritation, SAH
3) Explains purpose of interview
4) Establishes onset of symptoms and duration
5) SAH- Sensitive to the fact that patient is in severe distress and comment on need of
analgesia and antiemetic
6) Ask specifically about
a. SOCRATES
b. Associated factors: nausea, vomiting, visual disturbances (aura, double vision,
fortification spectra) photophobia, fevers or chills, weight loss, rash, tender
temporal artery, neck pain or stiffness, myalgia, rhinorrhea or lacrimation, altered
level of consciousness, neurological deficit
c. Timing
d. Exacerbating and relieving factors: activity, caffeine, alcohol, dehydration, stress,
eye strain, coughing or sneezing, bright lights, menses, hunger, certain foods
e. Severity- effect on the patients life
7) Establishes characteristic of headache :
a. Site
b. Radiation
c. Duration
d. Nature/severity
e. Relieving factors
f. Exacerbating factors
g. Precipitating factors
8) Establishes associated symptoms:
a. Meningism
b. Nausea and vomiting
c. Warning aura
d. Visual disturbances, blurring of vision
e. Weakness (in myasthenia gravis characteristic weakness increases with fatigue) and
tingling, excludes sensory symptoms- paraesthesia and numbness
9) SAH- neck stiffness, nausea, vomiting, mild photophobia, sudden onset headache- worst
ever, excludes fever and symptoms of upper and lower respiratory tract infection.
Establishes FHX of cerebro-vascular and renal disease, excludes previous history of
headaches specifically migraine.
10) Multiple Sclerosis- establishes retro-orbital pain and visual loss
