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Migraine Headache — History and Physical — Clinical Pathway: Inpatient

Migraine Headache Clinical Pathway – Inpatient

History and Physical

General

  • Use .ipneuro admit note for guidance on HA classification
  • Notify primary neurologist of patient admission

Complete History and Physical Exam

Characteristics of Headache
  • Location
  • Quality
  • Onset, duration
  • Headache frequency prior to this episode
Associated Symptoms
  • Nausea/vomiting
  • Photophobia/phonophobia
  • Auras are less common in children
  • Most common: visual disturbances, unilateral paresthesias
Red Flags
  • Seizure, weakness, focal neurologic sign/symptom
  • Thunderclap onset
  • Rapid progression of headache
Headache Triggers
  • Diet (caffeine, etc.)
  • Medications (OCP, retinoic acid, tetracycline)
  • Menstrual cycle (LMP)
Other Causes
  • Trauma
  • Infectious diseases
  • SHADDS
    • School, Home, Activities, Depression, Drug use, Sexual history, Safety
  • VP shunt
Analgesia
  • Dosing, frequency, type of medication used for current headache
  • Medications that were previously successful

Physical Exam

  • Vital signs, complete neurologic exam including fundoscopic exam
  • Signs of infectious disease, trauma, rheumatologic diseases

 

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