Paper Example on Patient's Headache: Questions to Get a Better History

For this patient, other questions that I would ask the patient to get a better history will include finding out the onset of the pain. Is it a rapid or slow onset? What are its location and character; is it stabbing, banging, tension or any other definition of nature according to the patient. Are there is any associated symptom such as tearing or having auras during the headache. Does the patient know of any factors that exacerbate the problem? I would also like to know if there is any other one of her family members who has had a similar history (Chawla, 2019).

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Headaches are classified as primary or secondary. Secondary headaches are those that are associated with another pathological derangement, while primary headaches are the ones which occur in the absence of any other disease (Raval, 2019). The diagnosis of primary headache is made by excluding all other causes of the problem. Some of the types of headaches that constitute primary headaches are migraine headache, tension headache, and cluster headaches. They all have different characteristics which help the healthcare provider to be able to identify them clinically.

I can determine whether my patient's headaches are of the chronic type or episodic type. The constant headaches, which are also known as old headaches, have longer lasting symptoms with higher intensity of pain than occasional headaches (Chawla, 2019). As explained above, the various forms of primary headaches have distinct clinical characteristics. Therefore, by asking some broad questions followed by specific ones, one would be able to determine accurately which type of headache it is (Banda, 2017). The patient's symptoms may also be used to determine whether the headache is benign or it needs urgent attention. For the benign cases, the patient may have some periods of spontaneous resolution of symptoms and the intensity of headaches will also be less. The duration of symptoms is useful as an indicator for whether the headache is benign or not. Headache that has lasted for a long time without having any changes in character may indicate a mild problem, unlike a situation where the headache lasted a short period in which the symptoms have worsened significantly.

The main diagnostic tests aim at ruling out any other causes of the headache so that we can be sure that it is a primary headache condition (Raval, 2019). They will include brain radiological studies like CT scan and a brain MRI. Some biochemical tests n the cerebrospinal fluid and inflammatory markers may also help to rule out inflammatory conditions of the brain.

Differential diagnosis flow sheet:

• Not associated with any other pathologies- Primary headache
• Associated with other pathologies- Secondary headache
• Fundoscopy revealing macular disease- diabetes
• Fundoscopy revealing retinopathy- hypertension
• Lumbar puncture done with positive findings- Meningitis
• MRI showing intracerebral lesion- soft tissue disease
• CT scan showing intracerebral lesion- Space occupying lesion
• Headache mostly unilateral, associated with auras and other symptoms such as dizziness and vomiting -Migraine headache
• Headache occurring in the frontal, temporal and occipital areas and is associated with a feeling of pressure around the head- Tension headache
• Headache occurring mostly in the frontal area and is accompanied by tearing- Cluster headache

References

Blanda, M. (2018, August 1). Cluster Headache: Background, Pathophysiology, Etiology. Retrieved from https://emedicine.medscape.com/article/1142459-overview

Chawla, J. (2019, February 4). Migraine Headache: Practice Essentials, Background, Pathophysiology. Retrieved from https://emedicine.medscape.com/article/1142556-overview

Raval, T. (2019, April 1). Facial Pain and Headache: Overview, Relevant Neuroanatomy, Sinogenic Facial Pain and Headache. Retrieved from https://emedicine.medscape.com/article/1048596-overview