Clinical examinations in headache

1. Big picture

The clinical examination of a headache patient has one main purpose:

To decide whether the headache is a primary headache, such as migraine, tension-type headache, or cluster headache, or whether it is a secondary headache caused by a dangerous disease.

Most headache patients have benign primary headache, but the examiner wants you to actively search for signs of:

• Subarachnoid hemorrhage

• Meningitis or encephalitis

• Intracranial tumor or abscess

• Raised intracranial pressure

• Cerebral venous sinus thrombosis

• Giant cell arteritis

• Acute glaucoma

• Cervical artery dissection

• Hypertensive crisis or posterior reversible encephalopathy syndrome

• Head trauma with intracranial bleeding

The key exam sentence:

Clinical examination in headache must include general examination, vital signs, neurological examination, fundoscopy, meningeal signs, cranial nerve examination, motor/sensory/cerebellar testing, and targeted examination of eyes, neck, temporal arteries, sinuses, teeth, ears, and cervical spine.

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