FIGURE 59.1 Approach to the diagnosis of headache After general health issues are covered, the clinician should then obtain a complete history regarding the headache itself As with many illnesses, the cause of headaches can usually be diagnosed with a high degree of accuracy solely based on history; the physical examination is often merely confirmatory One of the more important points to investigate is the mode of onset A headache that starts abruptly and causes extreme pain may represent a vascular event such as a ruptured arteriovenous malformation, whereas a headache with a more gradual onset would be inconsistent with this diagnosis It is sometimes useful to question the patient about the severity of the pain, although in younger children, this