Onset-when did the headache begin? Be specific! "Awhile ago", or "months" isn't a helpful answer. 3 weeks, 2 years, 5 days are much better. If a patient just can't come up with a specific onset, I through out ridiculous numbers. 5 years ago or yesterday? This usually makes them react ("not 5 years! Are you crazy!?"), and they are able to give a better timeframe; 3 months. I don't need to know the exact moment in time it occurred, but generally speaking. Days, months, years are all very different time frames.
Location-where on your head does it hurt? Back, on top, behind eyes, sides, only one side? These are all necessary to help us come to a diagnosis. Where on your abdomen is the pain? Right lower quadrant? Left upper quadrant? Again, location helps us narrow our list of differential diagnosis and order the appropriate tests/medications, etc.
Duration-how long does the pain last? Is it constant? Only a few seconds? Having a headache for 3 days is very different than 3-4 hours. Is the chest pain intermittent or constant? Again, we don't need exact times (unless you're in labor, of course, and in that case, we like to know how long the contractions are lasting and the time in between :)).
Characteristics-is it sharp, stabbing, aching, dull, pulsing, intermittent, pulling, cramping? Bust out all those adjectives and tell me about it! Nerve pain is characterized differently than muscular, so the more descriptive you can be, the better! For example, if every time you go to see Aunt Gertrude for dinner you begin sneezing, maybe you're allergic to her cat! Or, if every time you eat broccoli you experience severe abdominal cramping, maybe you need to avoid broccoli!
Aggravating factors-what makes it worse? Laying down, eating, lights, stress, loud noises, broccoli, walking, stairs, arguing, wind, cold weather, etc. The list goes on and on.....Migraines are usually aggravated by smells or light, if chest pain worsens with walking, we need to know that!
Relieving factors-what makes it better? Laying down, eating, silence, a dark room, deep breathing, rest, ice, Tylenol, avoidance, staying busy, counseling, walking, burping, passing gas, having a BM, etc. Again, the list goes on and on.
Treatment/timing-I prefer treatment, but have seen Timing used. IMO, timing is included in onset and duration. What treatment have you tried? Pain medication, ice, heat, deep breathing, Tums, a cup of coffee, a walk? This helps us determine a plan of care. When a patient tells me they haven't tried anything to fix their acid reflux, I will usually order an antacid and dietary changes. If after I write the prescription the patient tells me they have already tried this, it delays the process and I have to come back to this question.
There you have it! OLD CART!
Let me touch on Relieving factors again-if a patient has severe abdominal cramping after she eats broccoli, she has already identified the probable cause and is actively avoiding broccoli, I usually won't do any further work-up/treatment. She has found the cause, changed her diet, and now the symptoms do not return. This patient has solved her problem! A lot of patients still want the reassurance there is nothing else wrong. Trust yourself and your body! It's good to follow-up with us so we can make note of it in your chart, but if the symptoms have resolved, great! However, do not hesitate to come back if the symptoms return!
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