Headache (Cephalgia): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse [absolute arrhythmia? (thromboembolic risk)], body temperature [fever?], body weight, height; furthermore:
    • Inspection (observation).
      • Skin and mucous membranes
      • Head [tic douloureux, redness of the face].
      • Eyes (in cluster headache, at least one of the following characteristics (except for photophobia) occurs ipsilaterally (on the same side of the face)):
        • [photophobia.
        • Red or watery eye (conjunctival redness).
        • Miosis (temporary pupillary constriction) and ptosis (drooping upper eyelid).
        • Eyelid edema
        • Stuffy or runny nose (rhinorrhea and/or nasal congestion).
        • Sweating on the face (rarely also side-different).
      • Neck
        • Examination for meningismus [meningismus?/painfulness and increased resistance to movements of the head in the cervical spine; due todifferential diagnosis: meningitis (meningitis), unspecified].
        • Palpation (palpation) of the spine in the neck area [possibly muscle tension in the neck and neck].
      • Extremities [signs of paralysis]
    • Palpation (palpation) of the superficial temporal artery (bilateral).
    • Auscultation (listening) of the carotid artery and the heart.
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
  • Ophthalmic examination – including tonometry (measurement of intraocular pressure) [due todifferential diagnoses:
    • Ocular migraine (synonyms: ophthalmic migraine; migraine ophtalmique) – variant of migraine in which there are transient, bilateral visual disturbances (flickering, flashes of light, scotomas (restrictions of the visual field); similar to “normal” migraine with aura); often without headache, but sometimes with headache, which sometimes occurs only after the visual disturbances; duration of symptoms usually 5-10 minutes, rarely longer than 30-60 minutes Retinal migraine, in which only the retina, i.e. the retina at the back of the eye, is affected, must be distinguished from ocular migraine. i.e., the retina at the back of the eye, is affected – variant of migraine in which completely reversible monocular (“affecting one eye”), positive and/or negative visual phenomena (flickering, scotomas, or blindness) occur; these occur together with headaches that begin while the visual disturbances are still present or follow within 60 minutes
    • Glaucoma attack – eye disease with increased intraocular pressure]
  • Gynecological examination [due todifferential diagnosis: EPH gestosis]
  • ENT examination – including inspection of nasal (accessory) cavities [due todifferential diagnoses:
    • Nasal cavity tumors, unspecified.
    • Paranasal sinus tumors, not specified
    • Sinusitis (sinusitis)]
  • Neurological examination – including review/examination.
    • Sensorimotor function and reflexes
    • Cranial nerve functions
    • Paresis (paralysis)?, paresthesias (insensations)?
    • Visual disturbances?, bulbar pressure?, movement pain of the eyes?
    • Palpation of the trigeminal exit sites
    • Mobility of the cervical spine?
    • Meningismus (neck stiffness)?
    • Signs of a seizure event?
    • Vigilance (wakefulness)?
    • Orientation, memory, mental state
  • Dental examination [due todifferential diagnosis: cromandibular dysfunction – mainly caused by nocturnal teeth grinding (bruxism)].
  • Health check