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Migraine Headache — Complete History and Physical Exam — Clinical Pathway: Emergency

Migraine Headache Clinical Pathway — Emergency Department

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
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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