History taking other skills osce skills medistudents. Routine history taking begins with a set of standard questions that will elicit basic information and, depending on the acuity of onset, the age of the patient and whether heshe presents to you in the officeconsulting room or emergency departmentcasualty, you will need to elicit additional history. Headache, types, etiology, history taking and management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Key features in the history that support a diagnosis of migraine are nausea, photophobia, and disability, along with headache. Headache, types, etiology, history taking and management. Click on the image or right click to open the source website in a new browser window. Typical migraine aura a complex of reversible visual, sensory, or speech symptoms, which occurs during or precedes headache, is pathognomonic of migraine but only occurs in 15% to 30% of patients. G is a 54yearold hairdresser who reports pressure over her left chest like an. Taking a detailed history and performing a careful examination can help the doctor to determine the site of a specific neurological lesion and reach a diagnosis, or at least differential diagnoses. Headache is pain in any part of the head, including the scalp, face including the orbitotemporal area, and interior of the head. Headache history taking should include questions related to the time temporal profile, duration, severity, location and frequency of the headache syndrome, 19 other headache features, associated. Past medical history attach relevant documents and test results if applicable.
Drug history 28 prescribed medications 29 anticoagulants antiplatelets 30 over the counter medication. Migraine headaches are three times more common in women than in men. Specific questions vary depending on what type of history you are taking but if you follow the general framework. Clinical examination of patients with headache complaints.
It was a challenge to adopt a marmoreal attitude to a single therapeutic advance, triptans, serotonin 5ht 1b1d receptor. Case history for the headache patient the optometric. Headache is a common presenting complaint and certainly something youll encounter many times over your career. When you get your usual migraine headache, you often feel nauseated and experience sensitivity to light. These images are a random sampling from a bing search on the term headache history. An emphasis is made on the recognition of red flags that help in the identification of secondary headaches. History of presenting symptoms information to be volunteered at the start of the consultation you went to see your family doctor this morning whom you have not seen before. Evaluation of acute headaches in adults american family physician. Oct 12, 2012 history of headache patterns of headache. The doctors agenda, incorporating lists of detailed questions, should not dominate the history taking. Nov 09, 2015 the best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. History of presenting complaint 4 site of pain 5 onset of pain 6 character of pain 7 radiation of pain 8 associated symptoms 9 time course 10 exacerbating and relieving factors 11 severity of pain 12 asks if patient has experienced this symptom previously elicits patients ideas, concerns and expectations red flag symptoms 14 early morning. Your notes are very concise and a nice addition to my other resources.
Cohen refined a system for organizing the psychosocial history that was developed in 1972 by dr. Thankyou for taking the time to complete this important questionnaire. The nuances of headache historytaking are discussed in detail, particularly the questions related to the time, severity, location and frequency of the headache syndrome in general and the episode in particular. Jan 16, 2019 a good history is one which reveals the patients ideas, concerns and expectations as well as any accompanying diagnosis.
Migraine headache in adults symptoms, diagnosis and. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Headache is due to activation of painsensitive structures in or around the brain, skull, face, sinuses, or teeth. Presentation on evidenceinformed history taking and physical examination of patients with headache complaints in physiotherapy by rapannika in types research and headache examination physiotherapy history physical examinat. A careful history will allow clinicians to establish the correct diagnosis in most. Friedman suggests strategies for arriving at a correct diagnosis when taking a headache history. History of episodic migraine ihs history of increasing headache frequency with decreasing average severity of migrainous features over 3 months headache at some time meets ihs criteria for.
A careful history and physical examination is the most important part of the evaluation of the patient presenting to the ed with headache. History taking in neurology 2012 linkedin slideshare. The headache history is similar to other types of history gathering in medicine, but there are strategies and pointed questions that can help the physician arrive at a correct diagnosis. To be able to obtain a history that is targeted to the presenting complaint takes practice, as well as knowledge of possible differential diagnoses. The vast majority of headaches are not lifethreatening, with tension headache and migraine being the most common diagnoses. Ph is a 52 yo accountant with hypercholesterolemia and polycythemia vera who has.
Past medical history 23 headache migraine 24 intracranial bleeding 25 malignancy 26 other medical conditions 27 past surgical history. Headache history taking should include questions related to the time temporal profile, duration, severity, location and frequency of the headache syndrome, 19. Ravishankar department of neurology, consultant in charge, the headache and migraine clinics, jaslok hospital and research centre, lilavati hospital and research centre, mumbai, india abstract headache is a common complaint that makes up for approximately 25% of any neurologists outpatient. Chest pain when taking a history of chest pain ask the patient. Approach to history taking and the physical examination. History of episodic migraine ihs history of increasing headache frequency with decreasing average severity of migrainous features over 3 months headache at some time meets ihs criteria for migraine.
When taking an abdominal history, work through socrates before moving onto associated symptoms and abdominal history red flags. A detailed headache history helps to distinguish among the primary headache disorders. It tests both your communication skills as well as your knowledge about what to ask. When answering the following questions, if you dont remember the exact number of headache days, please give the best answer you can. When did you last take medication for your headache. Taking a history from a patient is a skill necessary for examinations and afterwards as a practicing doctor, no matter which area you specialise in. Headache is one of the most common reasons patients seek medical attention. If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. During that time, students will spend one full day per week in hospital or in general practice. The diagnosis of cluster headache is made by taking the patients history. Primary headache disorders, such as migraine and cluster headache, are the most common reasons, for which patients seek neurologic advice, and every year affect nearly 3 billion people 1.
The first major treatise about migraines was published in 1873 by edward liveing, however liveings theory explaining the cause of headaches differed from the accepted theory of vasodilation, instead. The art of historytaking in a headache patient request pdf. A comprehensive guide to taking a headache history in an osce setting. Did you suffer from headaches when you were younger. This helps to determine whether there is a significant risk for secondary headache and whether additional investigations are needed. General history taking taking the history of a patient is the most important tool you. Im an aspiring resident and hope this exam will be a nice bonus on my application. He found that putting a headache patient in a centrifuge to force blood from the head to the feet offered effective relief from headache pain. Comorbidities, along with the headache characteristics, guide where we go with the headache medications.
The art of historytaking in a headache patient ravishankar k. Short cases, history taking and communication skills fourth edition simon j bedwani mbbs mrcpch consultant paediatrician royal cornwall hospital, truro vanessa irvine bsc mbbs mrcpch consultant paediatrician western sussex hospitals nhs foundation trust, chichester r mark beattie bsc mbbs frcpch mrcp consultant paediatric. Humans have experienced headaches since ancient times. Case history of chronic migraine practical pain management. A careful history will allow clinicians to establish the. Mar 01, 2015 headache, types, etiology, history taking and management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. When to ask what question to elicit which information, is an art that is acquired by practice and improves with experience. The nuances of headache history taking are discussed in detail, particularly the questions related to the time, severity, location and frequency of the headache syndrome in general and the episode in particular. The medical admissions unit history of presenting symptoms information to be volunteered at the start of the consultation you were entirely well earlier today when, while sitting down at work, you suddenly experienced a. Check out the headache history taking osce mark scheme here. If a headache lasted more than one day, count each day.
The description of the pain and its clocklike recurrence is usually enough to make the diagnosis. Case history for the headache patient the optometric weekly. A comprehensive history needs time, interest, focus and establishment of rapport with the patient. The system has been used successfully around the world, in the adolescent health care field. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. You were well until last night when you became somewhat achey, shivery and tired. Many women experience migraines related to the hormonal changes of menstruation, oral contraceptives, pregnancy, postpartum and menopause. Foundations of physical examination and history taking. It is likely that ancient peoples believed that headaches were a sign of evil spirits, and evidence of ancient remedies to relieve what is thought to be headache pain can be traced back as early as 7000 bc. The art of historytaking in a headache patient ncbi. If you continue browsing the site, you agree to the use of cookies on this website. This video includes procedures for history taking and physical examination. Headache is however also associated with a number of serious conditions and therefore it is essential you are able to take a comprehensive headache history and identify red flags that indicate the need for further investigation.
Headache is an exceedingly common symptom in primary care and other practice settings, ranking among the top 10 most frequent symptoms that prompt an office visit. The purpose of this article is to be somewhat of a guide in dealing with this specific problem. Request pdf the art of historytaking in a headache patient headache is a common complaint that makes up for approximately 25% of any. Headache knowledge for medical students and physicians. Primary headache disorders neurology clinical practice. The headache patient riley is quoted as saying, if one should search for the human ill which has manifested. You are the patient, mrs barbara cassell, a 52year old woman location. Along with the chronic daily headaches and migraines, heather fits the mild end of the bipolar spectrum, has ibs primarily diarrhea, neck pain, and has struggled with weight gain. When did it start and was it a sudden or gradual onset. The abdominal pain history taking osce is a very common station and is often combined with an acute abdomen exam or a simple procedure such as urinalysis.
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