The history determines the accurate diagnosis; thus, questions need to be directed to both the child and parent (2,4,10). Children can provide useful information if questions are phrased appropriately. It is recommented to also obtain a separate interview with the adolescent patient. The physician should also note the interaction between patient and parent as it often reflects problems and conflicts not directly noted (10).

Chronic pain may be associated with anxiety and depression. Chronic pain may impact eating, sleeping, and playing. Emotional, behavioral, and personality factors assume even more importance as the child becomes an adolescent (10).

The history assesses the headache and its course over time. Headache calendars can be quite useful (7) and are extremely valuable for determining accurate headache frequency, severity, and disability (Table 129-1). They can demonstrate patterns of headache occurrence that may not be otherwise apparent. Triggers can be identified if the appropriate information is recorded. Pertinent information recorded on the calendar includes time of onset of the headache, the occurrence of any aura symptoms, and an assessment of the pain intensity, quality, and location. A visual analog scale may be included, making it easier for the younger patients to use. Associated symptoms, including photophobia, phonophobia, nausea, and vomiting, are also recorded. Patients then record the treatment, noting the time, medication, and dose used. Headache disability is assessed by determining if the headache interfered with activities. For many children, sleep deprivation is a significant trigger and attendance at sleepovers may precipitate a significant headache the following day. When completed, either by the parent or the child, the calendar gives an accurate picture of the child’s headache history (11). Symptoms of progressive neurologic dysfunction should be noted, along with the family history, past medical history, growth and development, review of systems, allergies, present and past medications, and educational and psychosocial status (10).