🚩 Red flags
Systemic: Fever, Weight Loss, Cancer, Immunocompromised.
Neurologic: Confusion, Altered mental status, Papilledema, Focal signs, Meningismus, Seizures.
Onset: New (esp age>40yo), Sudden (Thunderclap)
Other: Trauma, Drug use, Onset of headache with exertion, cough or sexual activity.
Previous headache hx with changes in freq, severity, clinical features.

HPI:
Freq, How many x in a month, Duration
Assoc S: Any N/V?
E/A: Worse with exercise?

Has anything like this happen previously?
Any recent changes in your headaches?
Recent Trauma?
Any recent changes in sleep, exercise, diet?

ROS:
Constitutional: Have you noticed any fever or weight loss?
HEENT: Do you have any trouble with your ears or hearing? Your eyes or vision? Your nose or sinuses? Your throat or voice?
Neuro: Any unusual sensations in your arms or legs? Weakness in your arms or legs? Trouble with balance or walking? Trouble with memory, headaches or dizziness?

PMH
Drug Hx: Recreational drug use?
Family Hx: Migraine?
Social Hx
Lifestyle Risk: Alcohol, Smoking
ROS

• Lesion in optic pathway: Visual field defects
• Optic Neuritis: Sudden, severe, unilateral vision loss
• ↑ICP: Blurring of vision on forward bending of head, headaches upon waking that improve with sitting up, double vision or loss of coordination and balance
• Intracranial Hypotension (Due to CSF leakage): Relieved with recumbency, Exacerbated with upright posture
• Tumor: N/V. Worsens with changes in body position (particularly bending over), an aAbnormal neurologic examination, and/or a significant change in prior headache pattern.