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Evaluation of the Patient
Take a very thorough HISTORY! 95% have normal physical exam.
FODLAR (frequency, onset, duration, location, association, and relief): Sharp, stabbing, pounding, throbbing? Is the patient a "headachy" person?
You should become concerned when . . .
- it's a new headache in a patient over the age of 50
- patient's headaches are increasing in frequency or severity
- headache wakes up patient from sleep
- the onset of headache is associated with an underlying medical condition or systemic illness
- headache with fever (spinal meningitis)
- headache with coughing or straining (brain swelling)
- patient's headache is accompanied by neurological symptoms
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Checklist
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HISTORY, HISTORY, HISTORY! |
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CN evaluation |
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Neurological workup when indicated |
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Blood pressure |
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Refraction |
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Binocular/accommodation testing |
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Sinus evaluation |
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Complete ocular health assessment |
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Visual field testing |
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Correct referral is usually to a neurologist; sometimes the family doctor/primary care physician is a more appropriate starting point. |
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Consider brain scan if suspect brain tumor, history of seizures, recent head trauma, significant changes in headache, and/or abnormal neurological signs. |
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