Headache Social History
Social factors may play a significant role in headache. The examiner should explore the patient’s marital and family status, education, occupation, outside interests, and friendships. Has the patient recently had a major life change, such as marriage, divorce, separation, a new job, retirement, or death in the family? Is work satisfying or merely drudgery? Is there conflict in the workplace? What is the patient’s employment? Exposure to drugs or toxins in the workplace may trigger headaches. Carbon monoxide exposure can occur in the workplace or the home due to poor ventilation. Inquire about other habits, such as the use of alcohol, tobacco, caffeine, or illicit drugs. A history of homosexual or bisexual activities should prompt a search for a potential infectious cause of the headache such as human immunodeficiency virus. Sleep habits may be significant. Sleep apnea is not un-common in middle-aged obese men and may cause morning headache.
Headache Family History
As some headache disorders are familial, it is useful to obtain a family history. Attempt to get a description of the headache and associated features, rather than accepting the patient’s diagnosis of the relative’s headache. Approximately 50% to 60% of migraineurs have a parent with the disorder, and as many as 80% have at least one first-degree relative with migraine. Cluster headaches rarely occur within the same family. Forty percent of patients with tension-type headaches have family members with similar headaches.
Familial headaches do not necessarily imply a genetic basis, although this seems to be the case in migraine sufferers. Shared environmental exposures may also cause familial headaches. For example, a leaky furnace may cause familial headaches induced by carbon monoxide.
Past Headache History
A history of prescribed medications and their dosages is useful for many reasons. First, treatment response may support a diagnosis. Second, a detailed history may help to explain past treatment failures. Unsuccessful treatment is often the result of incorrect dosing strategies or not allowing enough time to obtain a potential benefit.
The patient’s current approach to headache treatment should be reviewed. Many headache sufferers overuse medications, willingly or unwittingly. Many over-the-counter pain relievers contain caffeine with acetaminophen (paracetamol) or aspirin. Excessive use of these agents, as well as narcotics, barbiturates, and ergots, can produce withdrawal or rebound headaches.
Headache Multiplicity
It is not unusual for a patient to have different types of headache. The presence of pre-existing migraine does not exclude other, perhaps more ominous, types of headache.
Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.