What is the focus of the clinical history for the evaluation of facial pain and headache?

Updated: Jan 29, 2020
  • Author: Tejas Raval, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

The onset, duration, quality, location, and exacerbating and relieving factors of the pain are important points to elicit. The clinician should ask about any associated factors such as aura, tearing, rhinorrhea, nausea, and photophobia. A history of rhinitis, recurrent or acute sinusitis, purulent nasal discharge, and hyposmia should be elicited. Comorbid illness such as diabetes, hypertension, dental disease, psychiatric illness, or a history of head or facial trauma or prior surgery should be questioned. A review of systems should include constitutional symptoms such as weight loss, fatigue, fevers, and gastrointestinal complaints. The patient should provide a full list of his or her medications, as overmedication of headaches is a significant risk. [42] A social history should include a history of substance abuse, caffeine use, and use of alcohol or tobacco. A family history of migraine, other headache, or head and neck cancer should be noted.

A study by Eidlitz-Markus et al of pediatric headache patients found that organic comorbidities, including atopic disease, asthma, and first-reported iron-deficiency anemia, occurred significantly more often in in patients with migraine headaches than in those with tension headaches, while nonorganic comorbidities, ie, psychiatric and social stressors, were significantly more frequent in patients with tension headaches than in those with migraine. [43]


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