Headache/Migraine CO

Headache
Onset [text] prior to evaluation
Onset while:  [text]

Associated Pain (0=none, 10=severe)
Location: [text]
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration: [text]
Characterized as [text].

Pain modifiers
Relieved with [text]
Worse with [text]
[select value="no|YES"] <-- worse with bright light exposure.

Associated Symptoms:
[select value="no|YES"] <-- nausea/vomiting
[select value="no|YES"] <-- preceding aura before the headache (e.g. vision change, scotomata)
[select value="no|YES"] <-- blurred vision
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- sinus pressure or nasal drainage
[select value="no|YES"] <-- extremity weakness
[textarea memo="details"]

Impact
[select value="no|YES"] <-- missed days of work or school 
[select value="no|YES"] <-- missed life events
[select value="no|YES"] <-- avoidance of activities
[select value="no|YES"] <-- emergency room visits
[textarea memo="details"]

Pertinent PMH
[select value="no|YES"] <-- Migraine Headache
[select value="no|YES"] <-- frequent Sinusitis
[select value="no|YES"] <-- Glaucoma
[select value="no|YES"] <-- Head Trauma
[select value="no|YES"] <-- Serious CNS risks (e.g. active cancer, immunosuppression, HIV)
[select value="no|YES"] <-- Exposures (e.g. Tick bites, carbon monoxide, trauma, OCP)
[textarea memo="details"]

[select value="no|YES"] <-- Family history of cerebral aneurysm or stroke

[OBJECTIVE:
Vitals
General: WDWN, NAD [text]
HEENT: Normocephalic, EOMI, PERRLA [text]
Heart: RRR, no murmurs, rubs or gallops [text]
Lungs: CTAB[text]
Neuro: CN 2-12 intact [text], no nystagmus, radial pulse 2+ b/l, MS 5/5 at the knee and elbow, gross sensation to light touch intact at C7/8, L3/4, gait is balanced and non antalgic [text]
MSK: tightness [select value="noted|not noted"] at the trapezius, SCM, and cervical paraspinals. [select value= Decreased|Normal] ROM noted [text]. 

[Assessment/Plan
Patient presents to clinic with [text]
Differential Dx: [text]
Tests:[text]
Treatment: [text]
Follow up: [text]
Patient educated on [text]
Next steps if no improvement: [text]