Continuing our posts about headache, in this post we will review the assessment of the patient with a complaint of headache. 

Ascertain the following: 

Patient Medical History – Is this a first headache, or has the patient suffered from them in the past?  If so, at what age did the headaches first start?  From what other medical conditions does the patient suffer and when did they start?  Is the patient immunocompromised?  Has the patient suffered any falls, or trauma?   

Location of the pain – where is the pain on the head; is it on one side (unilateral) or both sides (bilateral); is it on the face? 

Radiation of the pain – Does it radiate to the forehead, face, jaw, neck? 

Quality of the pain – Is it throbbing, pounding, aching, sharp, dull, squeezing? What is the intensity of the pain – use pain scale 1-10 – mild, moderate, severe, incapacitating?  Is it the worst headache the patient has ever had (See *RED FLAGS, below)? 

Duration/Frequency of the pain – How often do the headaches occur? Are they always the same? How long do they last? Can you associate the headache with a time of day (Always in the morning or always in the evening); a time of the month; a time of the year?  Are the headaches recurring?  If so, what is the usual timeframe between episodes? What is the usual duration? 

Associated Signs/Symptoms – Is there fever, nausea, vomiting, congestion, flushing, muscle pains, depression, weight loss, dizziness, weakness, loss of consciousness, gait abnormalities, photophobia, phonophobia, stiff neck or dental problems? 

Aggravating/Alleviating Factors – What makes the headache better? What makes it worse? Is the pain affected by the position of the head or body? Is it associated with menses? 

Medications – Is the patient prescribed any medication? Is the patient taking any unprescribed medication? Is the patient taking any herbal supplements?  

Family history – Do any family members suffer from headaches like this one?  Do any family members suffer with cancer, stroke, diabetes, hypertension, seizures, or any other diseases affecting the head?  

*RED FLAGS when assessing patients with a complaint of headache 

The following are concerning symptoms that must be reported to a provider/addressed  immediately if reported by your patient: 

Acute onset, severe headache described as “the worst headache of my life;” thunderclap headache

Unrelenting headaches, unrelieved with conservative treatments or with pain that steadily worsens; 

New-onset headaches in patients over 50 years old without a previous history of headache; 

Lancing, “ice-pick” head pain; 

Severe headache associated with a stiff neck and/or fever; 

Persistent headaches following trauma to the head and neck; 

Headaches that are significantly different in pattern or severity in a patient with a longstanding chronic headache history. 

Obtain vital signs to include blood pressure, pulse, temperature, respirations, and oxygen saturation. If indicated by subjective, orthostatic vital signs may be necessary.  

HEENT:  Note the size, symmetry, and shape of the head. Inspect for bruises, masses, and/or nodules while palpating the head and neck. Palpate the temporal arteries. Assess the temporomandibular joint for clicking. Check for neck stiffness. Palpate the thyroid gland. Check for sinus tenderness, especially frontal and maxillary areas. Check visual function (Snellen Test) and extra-ocular movements, specifically looking for ptosis or miosis.  Check for tooth decay, oral abscesses, loose teeth, and other abnormalities of the oral cavity.  

Neurologic: Assess cranial nerves, muscle strength, reflexes, and cerebellar function. 

Pulmonary: Auscultate lung sounds, noting whether the respirations are easy and regular; and if there are adventitious sounds 

Cardiac: Auscultate for heart sounds, and if there are any murmurs, gallops, or rubs.  

Abdomen: Auscultate bowel sounds; note any distension, tenderness, guarding 

Extremities: Assess range of motion, ease of movement, gait.  

In our next post we will discuss Nursing Interventions for the patient with a complaint of headache.

This series of posts about headache is based upon The Correctional Nurse Educator class entitled  Headache for the Correctional Nurse.

 Please share your experiences caring for patients with a complaint of headache in our comments section below.