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Headache as a pain can be located in any part of the head including and not limited to the face, neck, orbital, or the scalp areas. According to Dunphy, Winland-Brown, Porter, and Thomas, (2015), it can be classified as tension headache (primary or secondary), migraine headache (vascular), cluster headache (vascular), mixed headache (a combination of tension and vascular), and traction or inflammatory headache.
Questions to ask the patient would include, for example, whether she is exposing to any substance (caffeine), or has a history of hypertension, cancer, has suffered any trauma, has suffered of coagulopathy, or any other member of the family had similar symptoms in the past or suffered of migraines. Exacerbating and alleviating factors are also included in the questionnaire.
The question on whether the headaches are chronic or episodic is answered when we learn that the patient began having these headaches after her first child two years ago. These headaches progressed gradually and became more intense in nature; although migraines are not always present, their occurrence can become more and more frequent.
It is possible to reach a diagnosis with the use of open-ended questions followed by focused questions. When open-ended questions are directed to the patient, the patient is allowed to expound in a more detailed and insightful manner. For example, â€œwhat brings you to the office today?â€, this allows to explain freely the reason for her visit. Once this sort of subjective information has been gathered, target questions can be asked to be more precise. Coming up with a diagnosis for this lady is possible this way if symptoms do not warrant of testing; altered mental status, or sudden/blunt headache, the presence of swelling of the optic nerve (papilledema), a blood pressure that is expediently high, or changes in neurologic condition, would necessitate further testing for diagnosis. This way, it is also possible to use the history to distinguish these headaches that appear to be benign, to a malignant one.
Although a diagnosis of migraine can be reached without testing. Further testing helps in ruling out other possible conditions or neurological problems. For example, tests like MRI, CT scan, lumbar puncture, or simple blood testing. According to Mayo Clinic, (2018), if a patient presents with migraines or a family history of migraines it is likely that a diagnosis may be given based on history, symptoms, and neurologic examination. The diagnosis of migraine lies in the history, and that the purpose of examination is primarily to look for other problems that may be exacerbating an underlying tendency to migraine (Weatherall, 2015).
Neuroimaging (MRI, CT, PET)
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary Care: Art and Science of Advanced Practice Nursing, 4th ed. PA: F. A. Davis Company.
Mayo Clinic. (2018). Migraine. Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207
Weatherall, M. W. (2015). The diagnosis and treatment of chronic migraine. Therapeutic Advances in Chronic Disease, 6(3), 115â€“123. http://doi.org/10.1177/2040622315579627
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