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Complete History and Physical Exam

The patient with refractory headache will typically present with:

  • Headache attack lasting 1-72 hours

  • Headache has at least two of the following four features:

    • Either bilateral or unilateral (frontal/temporal) location

    • Pulsating quality

    • Moderate to severe intensity

    • Aggravated by routine physical activities

  • At least one of the following accompany the headache:

    • Nausea and vomiting

    • Photophobia and phonophobia

  • Differential diagnosis

    • Tension headache

    • Cluster headache

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.