adult-headache

name: adult-headache description: Use when an adult (age 18 and over) reports a headache in themselves and is uncertain whether home care is appropriate, a pharmacy visit is needed, or emergency evaluation is required. Produces a three-way next-action decision — Call (emergency or hotline), Go (open pharmacy), or Wait (home self-care) — with the Yorukusu safety boundary on every output. Inputs include headache characteristics (onset, pattern, severity, location), concurrent neurological or systemic symptoms, recent trauma, known headache history, and the caller's Personal Health Context including anticoagulant use, blood-pressure control, and pregnancy status. Child and adolescent headache is out of scope for this skill. Never outputs a diagnosis and never recommends prescription medication.

Adult Headache Triage

Yorukusu does not diagnose. Pharmacist-informed, not pharmacist-replacing.

When to invoke this skill

Invoke when an adult caller (age 18 and over) is reporting a headache in themselves. Child and adolescent headache is out of scope; those callers should be routed to a pediatric pathway.

• [TODO-TM: enumerate the trigger keywords and phrasings in Japanese and English — including "頭痛", "頭が痛い", "偏頭痛", "headache", "migraine", and common variants. Specify how to disambiguate from facial pain, ear pain, dental pain, and sinus-specific complaints that have different triage paths. List the minimum confidence threshold before invoking versus asking a clarifying question, and the explicit age gate (caller reports themselves as adult).]

Required inputs

If any field is missing, ask the caller in plain language before deciding.

1. Caller confirms the patient is an adult (age 18 or over) and that they are reporting on themselves.
2. Onset character: gradual or sudden (thunderclap); if sudden, how many seconds or minutes to peak severity.
3. Severity on a 0-10 scale or plain-language equivalent ("worst headache of my life" is a specific red-flag phrase).
4. Location and quality (one-sided throbbing, pressure-band around the head, behind one eye, crown, occipital).
5. Duration of the current episode and whether this pattern is similar to prior headaches the caller has had.
6. Concurrent symptoms: visual changes, weakness, numbness, slurred speech, confusion, fever, neck stiffness, nausea / vomiting, light and sound sensitivity, seizure, recent head trauma.
7. Headache history: frequency and typical pattern, whether there is a known diagnosis the caller was previously given (caller-provided history only — Yorukusu does not diagnose).
8. Personal Health Context: anticoagulant or antiplatelet use, hypertension control, pregnancy status, known allergies to OTC analgesics, current daily medications that may interact with OTC analgesics, history of stroke or cerebral aneurysm in the caller or first-degree relatives.

Red-flag screening — output CALL immediately

Run red-flag screening FIRST, before any other branching. If any flag is positive, output CALL with that flag as the reason and stop.

• [TODO-TM: define the complete red-flag criteria set, including thunderclap-onset severe headache, "worst headache of life" phrasing, any focal neurological signs (weakness, numbness, visual-field loss, slurred speech, confusion), fever plus neck stiffness, post-traumatic severe headache, new headache pattern in an adult over a specified age band, new headache in a pregnant caller, new headache on anticoagulants, progressive headache over days to weeks, and headache with syncope or seizure. Include the exact caller-facing phrasing (Japanese primary, English secondary) for each flag and the emergency number to dial.]

Decision logic (no red flags)

After red flags are cleared, branch to one of CALL, GO, or WAIT.

• [TODO-TM: specify the decision tree for the non-red-flag path, stratified by pattern (typical migraine for a known migraineur, tension-type pattern, cluster pattern, post-viral or post- dehydration, medication-overuse concern). Define the thresholds on severity, duration, response to prior OTC analgesics, and PHC modifiers that move a case between branches. Document edge cases — first-ever migraine-like headache in an adult, recurrent night waking headache, headache in a pregnant caller who has cleared the red-flag step — explicitly.]

OTC guidance (WAIT and GO branches)

When the branch is WAIT or GO, the skill may surface OTC analgesic and symptomatic-care guidance drawn ONLY from the Yorukusu pre-approved OTC list. Never surface prescription medication.

• [TODO-TM: specify the pre-approved OTC analgesic options (single- agent and combination products available OTC in Japan), the caller-facing dose and timing guidance, medication-overuse guardrails (maximum dose-days per month phrasing), contraindications that escalate the branch (pregnancy, peptic ulcer history, anticoagulants, specific PHC interactions), non-pharmacologic measures (hydration, dark room, caffeine use), and the exact wording around "verify with the on-duty pharmacist before taking" for the GO branch. Include the named products (generic and common trade names) to surface.]

Output format

Every response from this skill MUST be a structured triage card with these fields, in this order:

1. decision: one of CALL, GO, WAIT.
2. reason: 1-2 sentences, caller-facing, in plain language. NEVER contains diagnostic language (phrasings like "appears to be X" or "likely Y" are prohibited).
3. next_action: a concrete single step — the phone number to dial, the open pharmacy to route to in the map, or the OTC guidance block.
4. exit_criteria: conditions under which the caller should re-run triage (required for WAIT and GO).
5. safety_boundary: the exact string "Yorukusu does not diagnose. Pharmacist-informed, not pharmacist-replacing."

Non-goals

• Never output a diagnosis.
• Never recommend a prescription medication.
• Never omit the safety_boundary field.
• Never skip red-flag screening.
• Never continue past a positive red flag on the same branch.
• Never handle child or adolescent headache — route to the pediatric pathway instead.