"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today because you've been experiencing headaches. Is that right?"
"Before we go any further, what are your thoughts about what might be causing these headaches, or what they might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"
"Could you please tell me more about your headaches? Where exactly is the pain – is it on one side or both? Is it in the front, back, or all over your head?"
"When did this headache first start? Did it come on very suddenly, like a thunderclap, or was it a more gradual onset?"
"How would you describe the pain itself? Is it throbbing, pounding, stabbing, a dull ache, or more like a pressure?"
"Does the pain spread anywhere else, like into your neck, face, or eyes?"
"Have you noticed any other symptoms happening with the headache? Such as nausea or vomiting? Are you sensitive to light (photophobia) or sound (phonophobia)? Do you get a stiff neck? Have you had any changes in your vision, or seen flashing lights or zigzags before the headache starts (aura)? Any fevers or rashes?"
"How has the headache changed over time? Is it constant, or does it come and go? Is it worse at a particular time of day, like in the mornings when you wake up?"
"What makes the headache better or worse? Does lying down or standing up affect it? Do painkillers help? What about rest, light, sound, or physical activity?"
"On a scale of 1 to 10, with 10 being the worst pain imaginable, how severe is your headache? And how much is it affecting your daily life or your ability to function?"
"I also need to ask about some important 'red flag' symptoms. Did the headache come on extremely suddenly, like being hit on the head? Have you had a fever or stiff neck? Any new weakness, numbness, or problems with your speech or balance? Have you had any recent head trauma? Is there any tenderness when you touch your temples, or pain in your jaw when chewing (jaw claudication)? Any unexplained weight loss or visual loss? Do you have a history of cancer or are you immunocompromised?"
"Have you had similar headaches before? If so, what were they diagnosed as (e.g., migraines, tension headaches, cluster headaches), and how were they managed?"
"Do you have any existing medical conditions, such as high blood pressure, diabetes, a history of stroke or epilepsy, known migraines, any clotting disorders, autoimmune conditions like SLE, HIV, or any history of cancer?"
"Have you ever had any operations or procedures, especially any surgery on your head or neck?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? Are you on oral contraceptives or hormone replacement therapy? What about any blood thinners or antiplatelet medications?"
"Have there been any recent changes to your medications?"
"Do you take painkillers very frequently for your headaches? Sometimes taking too many can paradoxically make headaches worse."
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you have?"
"Does anyone in your close family – like your parents, siblings, or children – have a history of headaches (e.g., migraine, cluster headaches), stroke, bleeding in the brain (like from an aneurysm), or clotting disorders? What about autoimmune conditions or cancers?"
"Could you tell me a little about your living situation and who you live with? Do you have a good support network around you? Are you able to manage all your daily activities?"
"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week? Do you use any recreational drugs, especially cocaine or amphetamines?"
"What kind of work do you do, and have you been exposed to any potential hazardous substances, like carbon monoxide, in your environment or at work?"
"Thank you very much for sharing all of that information with me. Just to summarise, you've been experiencing [recap key symptoms], which started [onset] and are often [character/timing]. This has been impacting your [daily life areas]. You've also mentioned [recap relevant PMH/DH/FH/SH]."
"Does that sound like an accurate summary? Is there anything else you feel is important that we haven't covered?"
"Based on what you've told me, the next steps would be for me to perform a physical examination, including a neurological examination and checking your vital signs. We might also consider some investigations, such as blood tests, or imaging like a CT scan or MRI of your brain. In some cases, a lumbar puncture might be considered."
"Do you have any questions for me at this stage?"
"Thank you for your time."