 Welcome to Approach to Headache Part 2. In this segment, we will discuss the high yield history and physical exam components for patients with headache. To refresh your memory, there are a few must-not-miss diagnosis of headaches in the emergency department. Within the brain, there are a diagnosis related to the blood vessels, including epidural, subdural, and subarachnoid bleeds, cerebral venous thrombus, space-occupying lesion in the parenchyma, including brain abscess and mass, and in the meninges and CSF, increased intracranial pressure and meningitis. Outside the brain, we are worried about acute-angle closure glaucoma and temporal arthritis, which can affect vision. And lastly, we're worried about carbon monoxide poisoning. These will be the main must-not-miss diagnosis. We will now discuss the history we will want to elicit based on these diagnosis. As with all history, generally, we will want to know about the onset of the symptoms, whether it is gradual or sudden onset, intermittent or constant, the severity, and the nature of the pain, what it feels like. We also want to know about associated symptoms such as nausea, vomiting, neurological deficits on history, and fever. Let's go into the specifics of each diagnosis. Let's first talk about the diagnosis that are in the brain. We'll first look at the blood vessels, and we'll focus on the bleeding diagnosis. For all the bleeding diagnosis, which includes epidural, subdural, and subreconoid bleed, we need to know whether the patient is more prone to bleeding, whether they have a hereditary bleeding disorder such as hemophilia, or whether they are on anticoagulants. For epidural and subdural bleeds, we need to know whether there is a history of head trauma. When it might have occurred, the GCS and level of consciousness of the patient at the time of the incident and compared to now. For subreconoid bleed, we need to know the onset of the headache, whether it had peaked at the time of occurrence, also known as a thunder clap headache. The activity of the patient at the time of the headache, whether they are exertion or at rest. And whether the patients themselves or their family has a history of brain aneurysms or a polycystic kidney disease. Continue with the other diagnosis inside the brain. For cerebral venous thrombosis, we need to ask whether the patient is at any increased risk of clotting. We need to know whether they are on any medication such as oral contraceptive pills or if there are any history of venous thrombosis. For patients with vasospasm leading to migraine, a history of migraine should be elicited. We need to know if this episode is similar to their previous migraine. If they have an aura or warning prior to their migraine. What is that composed of and are they similar to their previous aura prior to the migraine? Let's go into the parenchyma. In the brain parenchyma, we're most worried about space occupying lesion. That includes blood, abscess and mass. The blood here refers to parenchymo blood and not in the epidural, subduro or sub-recognized space. For parenchymo blood, we need to know about history of hypertension. Since that is the most common risk factor for parenchymo intracranial bleed. For abscess, we need to know about constitutional symptoms including fever, sick contacts and travel history and risk factors and other chronic illness that leads to immunocompromise. For mass, we need to know about the history of cancer, headaches that's worse than the morning, personality change. For CSF and meninges diagnosis. For hydrocephalus, we need to ask about gait disturbance and urinary incontinence. For intracranial hypertension or pseudotumus rebri. We will ask about vision changes and the use of oral contraceptive pills. For meningitis and cephalitis. We need to ask about history of fever, travel, sick contacts and their vaccination history. Let's move on to the outside brain diagnosis. Remember the main ones affect the eye and we also worry about carbon monoxide poisoning. For glaucoma, we need to know whether there is a history, whether they use any medications for it regularly and whether there are any new medications that might precipitate the increased intraocular pressure and whether there are any vision changes. For temporary arthritis, we need to ask about history of jaw claudication and proximal muscle weakness. For carbon monoxide poisoning, it's important to find out when the headaches occur. Does it only happen when the patient is at a particular building, either at home or at work, whether multiple people are affected and whether they have a carbon monoxide alarm in their building or in their home? For physical exam, we'll lump them all together. For the vital signs, we need to check for fever and whether there are any other abnormal vital signs. We also need to do a detailed neurological exam that includes the cranial nerve, paying special attention to vision in terms of visual acuity and visual fields. Moving downwards, we need to check for motor and sensory, both upper and lower extremities, and cerebellar testing, including gait and dysmetria. Going down the neck, we want to check for signs of meningio irritation. For the eyes, if you're worried about glaucoma, a slit-lamp exam and the measure of intraocular pressure should be obtained. We also want to feel the temporal artery to see if it's palpable or tender. Those will be the specific physical examination to examine for herpatients with headaches. In summary, we discussed the HAYU history and physical examination for patients with headache in the emergency department. We hope you find this useful. Thank you for watching.