History

Often the history is the total disease in the absence of any physical signs and it is important to note the nature of the pain, the total duration and frequency of the pain, the time of day it occurs, and its relation to other events or the taking of analgesics. Headaches that are present "all the time" and are described in fanciful terms tend not to have an organic basis; the patient with an organic headache is not usually smiling. The time of day could be important: raised intracranial pressure has the reputation of causing an early morning headache, which is described as bursting or throbbing and can be made worse by straining or coughing. We must always remember the triad of headache, vomiting and papilloedema in this respect, especially as the vomiting might not be accompanied by nausea, and is not necessarily mentioned by the patient. The family history should also be noted, especially where there is a history of migraine.

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