Optimizing headache history-taking: A structured approach from the International Headache Society Education Committee
Marcio Nattan Portes Souza, Kirill Skorobogatykh, Francesca Puledda, Roberta Messina, Mi Ji Lee, Amr Hassan, Henrik Winther Schytz, Sait Ashina, Amy A. Gelfand, Peter J. GoadsbyBackground
Headache disorders are among the most prevalent and disabling conditions worldwide. Diagnosis of primary headache disorders, including migraine, depends largely on clinical history and neurological examination, while secondary headaches require timely recognition of alarm signs. In routine practice, suboptimal communication can lead to incomplete histories and misalignment between patient experience and clinician assessment of key variables such as frequency, disability, and risk features. A systematic approach is needed to integrate diagnostic frameworks with patient-centered communication to elicit accurate information while maintaining rapport.
Methods
We conducted a narrative review and expert consensus from the International Headache Society Education Committee to outline a structured approach to headache history-taking.
Results
The proposed framework begins with early rapport-building using open-ended prompts and active listening to capture the patient's narrative. It then guides a structured characterization of headache presentations (quality, intensity, timing, associated symptoms, triggers, and disability), alongside targeted screening for secondary headache warning features using the SNNOOP10 framework and temporal pattern analysis. The framework incorporates validated outcome measures (e.g., MIDAS, HIT-6), assessment of psychiatric and social context, and use of headache diaries to support longitudinal monitoring and treatment optimization. Pediatric adaptations address developmental stage, caregiver participation, and age-appropriate assessment of disability and red flags. The review also discusses digital and AI-enabled tools to support pre-visit history capture, headache diary analytics, and structured clinical documentation.
Conclusion
A structured, empathic history remains the cornerstone of headache medicine and the primary tool for distinguishing primary from secondary disorders. Integrating ICHD-3–based diagnostic reasoning with patient-centered communication and standardized measurement tools may strengthen therapeutic partnership, improve adherence, and support more judicious use of investigations.