NAME AGE SEX

SCAN.NO DATE PART

PROTOCOL

HEADACHE

Present Illness
Is it acute , subacute or chronic Duration Is the problem present always or how long each episode lasted How many times headache occurred What time of the day headache occurs Any relation to food , tension , job other physical work Relieved with drugs Associated symptoms Nausea or Vomiting Headache , ear pain Black out / Loss of consciousness Visual disturbances Focal neurological deficit Weakness Fever

Past History
Any similar illness in past How long the illness present or At what age did it start Any other chronic diseases present Diabetes , High BP , Asthma , Heart disease, Liver disease , Kidney disease , Allergy Any surgery

Family History
Any other family member having similar illness , migraine

Other imaging investigations

CT Scan MRI X-ray

Lab Reports

Blood Urine CSF

Drug history

Any history of allergy to drugs Any history of allergy to contrast media Any other contraindications to drugs