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Evaluation of patients with chronic headache
1Johnson City Family Care Center, New York, USA.
American Family Physician
|September 1, 1996
Summary
A thorough patient interview is key to diagnosing chronic headaches. Understanding pain characteristics (PQRST) and associated symptoms helps identify causes and guide effective treatment strategies.
Area of Science:
- Neurology
- Clinical Diagnosis
Background:
- Chronic headache syndromes are prevalent and often complex.
- Accurate diagnosis is crucial for effective management.
Observation:
- A detailed patient interview is the primary diagnostic tool.
- Exploring pain characteristics (provocation, quality, region, strength, time course) and associated symptoms is essential.
- Medication overuse and psychosocial factors like depression can contribute to chronic headache.
Findings:
- The time course of pain is the most helpful element in interviews.
- Associated symptoms (e.g., nausea in migraine) and medication history are vital clues.
- Neurologic examination findings are typically normal; focal findings warrant imaging.
Implications:
- A comprehensive interview approach can accurately identify most chronic headache syndromes.
- Targeted laboratory and imaging studies should be guided by interview findings.
- Addressing medication overuse and psychosocial factors is critical for managing chronic headaches.