Migraine Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Site and nature of the pain (e.g. throbbing, dull ache) - “Where do you get the pain?”, “how would you describe the pain?”
Duration of pain - “how long does the pain last for?”
Speed of onset (to help exclude a subarachnoid haemorrhage) - “how long did it take to reach its maximum pain level?”
Frequency and time of day - “How many times in a day do you get the headache?”, “what time of the day do you normally get the headache?”
Aura / visual symptoms (including photophobia) - “Do you have any warning signs or visual symptoms?”, “do you get very sensitive to light, that you want to shut yourself in a very dark room?”
Nausea/vomiting/phonophobia - “Do you get any nausea? Any vomiting? Any sensitivity to noise?”
Precipitating factors including stress, food (cheese, red wine, chocolate, coffee, dehydration) or relieving factors like analgesia - “Does any bring on your headache, like stress or certain foods like cheese, red wine or caffeine?”, “What is your stress level like currently?”, “Does anything make your headache better? Have you tried anything to help your headache?”
Frequency of analgesia to screen for analgesia overuse - “How many times in a day do you use pain-killers?”, “what about in a week?”
Elicits why attended today and not sooner - “What made you come in today and not earlier?”
PMH
“Do you have any medical conditions like any headaches in the past?”
DH
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
FH
“Does anyone in your family have issues with headaches?”
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”, “How is the headache affecting your day-to-day life?”
ICE
Ideas - “what do you think could have caused your headaches?”
Concern - “is there anything that your worried about regarding your headaches?”
Expectation - “what were you hoping we would do for you today?”
Examination
Asks to examine patient
“Would it be alright if I examine you by taking your blood pressure and looking at the back of your eyes?”
Counselling
Lifestyle changes: headache diary / avoidance of triggers / better hydration but less coffee/sleep - “Going forward, we would advise that you keep a headache diary and make some lifestyle changes like drinking less caffeine, making sure you’re well hydrated and getting more sleep at night”
Makes a suggestion to improve management of acute attack (e.g. aspirin at onset, stronger NSAID, triptan) - “To help with the headaches, you can take aspirin when you feel them starting, or alternatively another medication called triptans which I can prescribe for you”
Mentions medication for prophylaxis can be used (b-blocker or topiramate or amitriptyline) - “also to help prevent the migraine, you can take propranolol (which is a beta-blocker) or amitriptyline (which is an anti-depressant).”
“Do you have any questions for me?”
Safety-netting
“If you notice any further symptoms like pain in your head that feels like someone has hit you with a cricket bat, double vision or fever, it’s important that you come back to the surgery or go to A&E for an urgent review”
Close consultation
- “Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll write on a piece of paper for you to take home with you.”*
- “I would also like to arrange a follow-up appointment with you for 1-2 weeks time? Is this ok with you?”*
- Thanks once again for your time, have a good day*
