Symptom: Headache

Initial Grading Reminder

Grade 1: Mild pain
Grade 2: Moderate pain; limiting instrumental ADLs
Grade 3: Severe pain; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had headaches in the past? Is the melanoma known to be in your brain? Is this a new or worsening symptom? When did it start or get worse? Is it a new or worsening headache? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How bad is your headache? How is it affecting your life? Does anything give you relief?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Is this the worse headache you ever had in your life? Do you have a fever, neck pain or stiffness, a rash or any vision changes? Have you had any hallucinations? Do you have any nausea/vomiting or extreme fatigue?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new-onset moderate or worse (or worsening) headache should be seen. Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of the headache?