8 questions for a thorough history to diagnose migraines

January 22, 2020

When evaluating and diagnosing migraines in pediatric patients, a thorough medical history is key to giving a diagnosis. These 8 questions are structured to pinpoint concerning headache patterns earlier in the diagnosing process.

What is the pattern of your headaches, and at what time of day do they occur?

Notes/Rationale

Acute onset of first episode, without prior history

Recurring headache with symptom-free intervals

Chronic pattern of progressively increasing headache

Nonprogressive daily or near-daily headache

Mixed pattern of daily headache with more intense attacks superimposed

How and when did your headaches begin?

Notes/Rationale

Establish origin/history of attacks

How often do they occur, and how long do they last?

Notes/Rationale

Identify characteristics patterns. A weekly 4-h attack suggests migraine or TTH; brief attacks occurring multiple times daily suggest TACs

Notes/Rationale

Holocephalic

Bifrontal

Unilateral

Posterior

What is the quality of the pain?

Notes/Rationale

Throbbing/pounding

Squeezing/pressure

Stabbing

Other

What other symptoms accompany your headaches?

Notes/Rationale

Nausea, vomiting, abdominal pain

Visual aura, diplopia

Photophobia/phonophobia

Vertigo/dizziness

Motion sickness, nocturnal leg cramps

Numbness/weakness

Does anyone in your family from headaches?

Notes/Rationale

Use the open-ended term “headache,” not “migraine”; parents’ migraines may have been misdiagnosed as other headache types.

What do you think might be causing your headaches?

Notes/Rationale

Possibly the most important question-children and parents’ main fear is usually a brain tumor. Normal physical and neurological examinations can provide reassurance.