Topic: Headache

Process and Diagnostics

Your objective is to determine diagnostic workup based on the differential diagnosis for clients presenting with an episodic illness in the care setting.

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. Diagnosis and management are based on a careful clinical approach augmented by an understanding of the anatomy, physiology, and pharmacology of the nervous system pathways that mediate the various headache syndromes.

A 35-year-old woman comes to your office to discuss her “bad headaches,” which started after having her first child 2 years ago. The headaches sometimes awaken her from sleep and at times can be disabling and occasionally require her to take Tylenol and rest in a dark room. Sometimes she vomits during an attack. Over the past 6 months, her headaches have become more severe and frequent, prompting her visit today.

• What additional questions would you ask to learn more about her headaches?
• How do you classify headaches?
• How can you determine if this is an old headache or a new headache/s? Is this a chronic or episodic condition?
• Can you make a definite diagnosis through an open-ended history followed by focused questions?
• How can you use the patient history to distinguish between benign headaches and serious ones that require urgent attention?
• What diagnostic tests do you want to include to help you with your diagnosis? Who might you refer this patient to see and why?
• Create a differential diagnosis flow sheet for this patient and include the diagnostics related to the differentials.
• Please support with up-to-date evidence-based standard of care guidelines.