8 questions for a thorough history to diagnose migraines
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.
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.