Headache
Onset prior to evaluation
Onset while:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Duration:
Characterized as .

Pain modifiers
Relieved with
Worse with
<-- worse with bright light exposure.

Associated Symptoms:
<-- nausea/vomiting
<-- preceding aura before the headache (e.g. vision change, scotomata)
<-- blurred vision
<-- fever
<-- sinus pressure or nasal drainage
<-- extremity weakness
details

Impact
<-- missed days of work or school
<-- missed life events
<-- avoidance of activities
<-- emergency room visits
details

Pertinent PMH
<-- Migraine Headache
<-- frequent Sinusitis
<-- Glaucoma
<-- Head Trauma
<-- Serious CNS risks (e.g. active cancer, immunosuppression, HIV)
<-- Exposures (e.g. Tick bites, carbon monoxide)
details

<-- Family history of cerebral aneurysm or stroke

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Result - Copy and paste this output: