8 questions for a thorough history to diagnose migraines

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.