Tension Headache: Examination

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

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing) of skin and mucous membranes; dentition [bite marks inside mouth: suspicion of bruxism].
  • Palpation (palpation) of the spine in the neck area [possibly muscle tension in the neck and neck].
• Ophthalmological examination – including tonometry (measurement of intraocular pressure) [due todifferential diagnosis:
  • Glaucoma attack – eye disease with seizure-like increased intraocular pressure]
• ENT examination – including epipharyngoscopy (nasopharyngoscopy) and laryngoscopy (laryngoscopy) [due todifferential diagnoses:
  • Chronic frontal sinusitis (sinusitis).
  • Nasal cavity tumors
  • Paranasal sinus tumors]
• Neurological examination – including review/examination (note: an unremarkable neurological status is essential for the diagnosis of tension headache/migraine).
  • 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

Square brackets [ ] indicate possible pathological (pathological) physical findings.