FIRST or WORST headache ever? DIFFERENT from usual headaches? Onset = when did it start? gradual, sudden (thunder-clap) prodrome, aura Palliation/Provocative stress, food, menstrual cycle, rest Quality unilateral, bilateral, band-like? does it spread? throbbing, stabbing, dull, pressure Radiation where does it spread? Severity Nausea/vomiting photo/phonophobia vision changes fever stiff neck confusion General systemic illness: weightloss CNS: change in mentation, personality, aura headaches beginning at age 40 mass lesion, temporal arteritis mass lesion, subdural hematoma, medication overuse, post-coital headache/migraine SAH, mass lesion (especially in the posterior fossa) new onset in patient with risk factors for HIV or CANCER meningitis, brain abscess, metastasis fever (meningitis, encephalitis, systemic infection) projectile vomiting impaired mental status focal neurological signs - weakness, paresthesia (mass lesion, stroke) recent head injury papilledema (mass lesion, pseudotumor, meningitis) meningismus (meningeal irritation) seizures trauma (intracranial hemorrhage, subdural/epidural hematoma, SAH) Hypertension HIV Cancer Trauma Recent procedures Analgesic abuse Recreational drugs Birth control Migraines Subarachnoid hemorrhage Stroke
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