POSSIBLE CAUSES OF HEADACHES

& QUESTIONS TO ASK

This is a helpful list to review differential diagnosis for headaches. The is not an all-inclusive list. There are also several other questions that can be asked for each differential diagnosis.

• Migrane

  • Any aura with headache?
  • Ever had this  in the past?
  • Does it feel like a vice grip? (think tension headache)
  • Is it unilateral or bilateral? (unilateral often cluster type)
  • Any vision changes? Floaters, zig zags, shapes, flashes of light, bright spots?
  • What time of day does it come on?
  • Any aggravating factors?
  • Does smell cause seem to be related to the headache?
  • Any nausea or vomiting?

• Sinusitis

  • Any facial pressure?
  • Any green drainage from nose?
  • Any upper tooth pain?
  • Do you have a history of seasonal allergies?
    • If yes, ask: Have they been getting worse lately?
    • Do antihistamines or fluticasone improve symptoms?
  • Any fever or chills?

• Medications Started or Stopped

  • • Any recent medications stopped abruptly?
    • Have you started any new medications?
    • Any medication dosage adjustments?
    • Any alcohol abuse or illicit drug use?

• Meningitis

  • Do you have a stiff neck?
  • Have you had a fever?
  • Have you had a recent infection?
  • Do you have light sensitivities?

• Temporal Arteritis

  • Any scalp pain?
  • Any joint stiffness in neck, shoulder, or hips?
  • Any pain in upper extremities?
  • Any changes in vision?
  • Any jaw pain or muscle spasms of the jaw ?Any pain when chewing? (Major)
  • Any wrist or knee swelling?

• Caffeine Withdrawal

  • Have you decreased caffeine intake recently?

• Stroke

  • Any unilateral weakness?
  • Any facial droop?
  • Any confusion?
  • Any speech difficulties?
  • Any gait disturbances?
  • Any swallowing difficulties?

• Subdural Hematoma

  • Any recent head injury, fall, hitting your head on anything?
  • Any nausea or vomiting?
  • Any vision changes?
  • Any change if eye, verbal, motor responses?
  • Any recent seizure?
  • Any weakness?
  • Any sensory changes?

• Trigeminal neuralgia

  • Any facial pain?
  • Do you have electric shocks in face?
  • Does the jolts of pain happen after touching face, brushing teeth, chewing, speaking?
  • Is there a constant aching or burning sensation that turns into a muscle spasm?
  • Pain in cheek, teeth, gums, eyes, forehead?

• Dehydration

  • Any decreased urine output?
  • Dry mouth?
  • Recently out in sun for long period of time?
  • Recent decreased fluid intake?

• Influenza

  • Do you have any muscle aches?
  • Do you have any fevers or chills?
  • Any coughing? Is it dry?
  • When did it start?
  • Any rashes?
  • Do you feel like you got hit by a truck?

• Sleep Apnea

  • When is your headache-first thing in the morning?
  • Do you have day time sleepiness?
  • Do you fall asleep often throughout the day?
  • Do you feel fatigue and drained throughout the day?
  • Have you been told you snore?
  • Have you been told you gasp for air or stop breathing multiple times during the night?

• Lifestyle Causes

  • What is your sleep pattern and how many hours a night?
  • Do your headaches happen after drinking alcohol like wine?
  • Do you eat processed meat often (foods containing nitrates)?
  • Do the headaches come on after skipping meals?
  • Do the headaches come after work?
  • Do you carry stress and tension in your shoulder, neck area?

• Carotid or Vertebral Dissection

  • Do you have any scalp, neck, eye, and or facial pain?
  • Is the pain constant and severe?
  • Has your eyelid drooped? (Horner syndrome-check pupil if small)
  • Any recent chiropractor adjustments?
  • Any recent heavy physical activity?
  • Any numbness or tingling on one side of your body?
  • Any whooshing sound or pulsation in your  ear?
  • Any speech difficulties?

• Glaucoma

  • Open-Angle
    • Any peripheral blind spots?
    • Any tunnel vision?
  • Acute angle-closure
    • Any eye pain or pressure?
    • Is your headache severe?
    • Any blurred vision?
    • Any nausea or vomiting?
    • Any halos around lights?
    • Any eye redness?