Most chronic headache syndromes can be identified by conducting a care
ful interview that yields a thorough understanding of the patient's he
adache experience. The interview should explore the PQRST of the pain:
provocation, quality, region, strength and time course, with the last
element being the most helpful. Associated symptoms, such as nausea a
nd vomiting in migraine, can be clues to the etiology. A list of all c
urrent medicines and the frequency of use should be obtained, since ov
eruse of Various analgesics can convert paroxysmal migraine into chron
ic daily headache. Psychosocial issues should be addressed, since depr
ession can manifest as chronic headache. Changes in mood, energy, appe
tite, sleep, libido, enjoyments and suicidal ideation (represented by
the acronym MEASLES) can indicate depression. A neurologic examination
is important, and any focal findings warrant tomographic imaging of t
he brain. Findings on physical examination, however, are usually norma
l in patients with chronic headache. Laboratory and imaging studies ar
e of most value when targeted to elucidate potential diagnoses raised
by the detailed interview.