EVALUATION OF PATIENTS WITH CHRONIC HEADACHE

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.