Common Presenting Symptoms:
When there is a pain, please remember SOCSRATE:
ite: Unilateral/Bilateral? Localization/Generalized?
nset: When? Quick/Gradual?
haracter: Use patient’s own description, sharp/ dull?
ssociating factor: Lacrimation, rhinorrhoea?
iming: Last for how long?
xacerbating/relieving factor: e.g. trigger by light?
Several typical headache:
- Unilateral, throbbing, associated with nausea, Last from
6hr–3days then weeks/months pain-free interval
- Similar to classic migraine, but without other focal
symptom, can be cyclical (in women, menstruation can
- Unilateral , localized in cheek/temple/around eye,
excruciating, with ptosis/lacrimation/rhinorrhoea, last from
30min – 3hr
- Bilateral, ‘Like a tight band’, worst to end of day
Some typical and important diagnosis:
- Generalized, with drowsiness, vomiting
- Generalized, gradual onset, with fever & stiff neck
- Unilateral, knife-like/burning, affect single nerve
innervation, last seconds 1 time, and recurr over several min
(* some neuralgia e.g. CN V&IX trigger by some activity
e.g. brush teeth, shaving, eating)
- Sudden onset, bilateral locate by patient with snaps of
finger, worst in occipital region. With nausea
/vomiting/impair conciousness/ meningial irritation sign
- Unilateral, sudden onset, throbbing, with general malaise
if patient has recent onset aged > 55yr, consider temporal
2. Syncope, seizure:
Syncope = loss of consciousness due to recoverable loss of
cerebral blood flow
- Caridac syncope = syncope due to reduce cardiac output
- Vasovagal = syncope due to peripheral vasodilation
Seizure(fit) = loss of consciousness due to dysfunction of
electric control of brain
- Partial seizure = seizure not affect only part/one side body
- Complex partial seizure = impair consciousness in seizure
- Simple partial seiz