Medical Record Review
Documentation of Migraine: The Pattern is in the History
Editors: Lawrence F. Nazarian, MD.
Although a complete and accurate history is important in all areas of medical care, some conditions are diagnosed almost completely on the basis of historical details. Distributed with this issue of Pediatrics in Review is the Guide for Record Review on migraine written by the American Board of Pediatrics, which states, "Because there is no diagnostic test for migraine, a careful history provides the most important clues to the diagnosis."
Headache is a common complaint in the pediatric office; it can be part of an acute illness or an isolated symptom that plagues the patient for years. Usually headache is annoying; sometimes it can be debilitating. In the worst case, but rarely, headache can be a manifestation of a serious underlying condition, such as a brain tumor. The physician's first task is to ascertain whether such a disorder is present. The history will help to determine this, but physical findings are especially important. A physical examination, with special attention to neurologic findings, can detect signs of a disease or disorder. Usually, results of the examination will reassure patient and physician, especially if the headaches have been occurring for many months and the findings are normal.
The clinician's next step is to determine the mechanism for the patient's discomfort, which will dictate appropriate therapy.
