How to interview a patient with a headache
Other platforms explain it with text and video. In VMS you practice it on the patient.
Most headaches are migraine or tension-type, but a few are emergencies. The interview is the main tool to find the dangerous ones, so ask about the red flags in every patient.
Step by step
Introduce yourself and get consent
Dim the light if bright light hurts and keep your voice calm. [1]
Onset
How fast did it reach its worst? A headache that peaks within a minute ("the worst of my life") is a red flag for bleeding in the brain. [2]
Pattern and description
Where it hurts, type (throbbing, pressing, stabbing), how long, how often, time of day and if it is new or the same as always. [2]
Triggers and relief
Light, noise, coughing or straining, lying down or standing, food, sleep, stress, and what medicines help. [2]
Associated symptoms
Nausea, vomiting, light sensitivity, aura (visual zigzags before the pain), fever, stiff neck, rash, weakness, numbness, speech or vision changes. [3]
Red flags
New headache after 50, pain on chewing or scalp tenderness, recent head injury, blood thinners, cancer, weak immune system, pregnancy, or worse on waking and on coughing. [3]
Medication use
How many days a month they take pain relievers. Taking them on many days can itself cause daily headaches. [3]
Summarize and plan
Name the most likely type, say if a red flag is present and explain the next step. [1]
Common errors
- Not asking how fast it started.
- Skipping the red flag questions because the patient has had migraines before.
- Not counting pain-reliever days.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- AAMC Core Entrustable Professional Activities (Core EPAs)
- NBOME COMLEX-USA clinical presentations
- NCCPA PANCE Content Blueprint
Facts and steps follow NBOME COMLEX-USA clinical presentations; NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.