Migraine Headache with Worsening

Pre-Worsening Headache Baseline

Age of onset

Migraine diagnosis date

HIPAA: Only the year will appear in summaries

Pain quality and location: throbbing, located on one side of the head

Pain Intensity: moderate-severe

Duration: 4-72 hours, may have prodromal and postdromal stages

Nausea/vomiting, dizziness, sensitivity to light/sound/smell, irritability

Symptoms exacerbated by movement

Symptoms improved by laying in dark quiet room and/or sleep

Days per week patient experiences any form of headache and duration

Days per week patient experiences very severe headache and duration

Onse of headache worsening

Features of current headache are similar to baseline headache

Features of current headache are different from baseline headache

Pattern or precipitants identified for worsening

Aggravating factors

Relieving factors

Missed days of work or other activities

ICHD3 Migraine

Past medications (over the counter and/or prescribed) and supplements tried

Non-pharmacologic measures tried (neurostimulation devices, massage, biofeedback, acupuncture)

Recent visits to urgent care/ED for acute treatment, medications given and effectiveness

History of:

Blood tests

Prior brain and/or vessel (arterial, venous) imaging performed

Prior lumbar puncture performed

Other diagnostics