Migraine physical examination: Difference between revisions
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Signs that suggest a more serious cause of headache: | Signs that suggest a more serious cause of headache: | ||
* Systemic symptoms (ie. [[myalgia]], [[fever]], [[weight loss]], [[scalp]] [[tenderness]], [[jaw claudication]]) and | * Systemic symptoms (ie. [[myalgia]], [[fever]], [[weight loss]], [[scalp]] [[tenderness]], [[jaw claudication]]) and | ||
* | * Focal neurological signs or | ||
* [[Confusion]], [[seizures]] or | * [[Confusion]], [[seizures]] or | ||
* Any impairment of level of [[consciousness]] | * Any impairment of level of [[consciousness]] | ||
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Focal neurological signs that occur with the headache and persist temporarily after the pain resolves suggest a migraine variant: | Focal neurological signs that occur with the headache and persist temporarily after the pain resolves suggest a migraine variant: | ||
* Hemiplegic migraine: unilateral [[paralysis]] or [[muscle weakness|weakness]]<ref> name="pmid17614229">{{cite journal| author=Hsu DA, Stafstrom CE, Rowley HA, Kiff JE, Dulli DA| title=Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil. | journal=Brain Dev | year= 2008 | volume= 30 | issue= 1 | pages= 86-90 | pmid=17614229 | doi=10.1016/j.braindev.2007.05.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17614229 }} </ref> | * '''Hemiplegic migraine:''' unilateral [[paralysis]] or [[muscle weakness|weakness]]<ref> name="pmid17614229">{{cite journal| author=Hsu DA, Stafstrom CE, Rowley HA, Kiff JE, Dulli DA| title=Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil. | journal=Brain Dev | year= 2008 | volume= 30 | issue= 1 | pages= 86-90 | pmid=17614229 | doi=10.1016/j.braindev.2007.05.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17614229 }} </ref> | ||
* Basilar type migraine: [[dysarthria]], [[vertigo]], [[tinnitus]], [[diplopia]], [[ataxia]], decreased level of [[consciousness]], simultaneous [[Paresthesia| paresthesias]]<ref> name="pmid15039036">{{cite journal| author=Schoenen J, Sándor PS| title=Headache with focal neurological signs or symptoms: a complicated differential diagnosis. | journal=Lancet Neurol | year= 2004 | volume= 3 | issue= 4 | pages= 237-45 | pmid=15039036 | doi=10.1016/S1474-4422(04)00709-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15039036 }} </ref> | * '''Basilar type migraine:''' [[dysarthria]], [[vertigo]], [[tinnitus]], [[diplopia]], [[ataxia]], decreased level of [[consciousness]], simultaneous [[Paresthesia| paresthesias]]<ref> name="pmid15039036">{{cite journal| author=Schoenen J, Sándor PS| title=Headache with focal neurological signs or symptoms: a complicated differential diagnosis. | journal=Lancet Neurol | year= 2004 | volume= 3 | issue= 4 | pages= 237-45 | pmid=15039036 | doi=10.1016/S1474-4422(04)00709-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15039036 }} </ref> | ||
* Ophthalmoplegic migraine: [[oculomotor nerve palsy| Third nerve palsy]], with ocular muscle [[paralysis]] and [[ptosis]], including or sparing the [[pupillary response]]<ref> name="pmid19389140">{{cite journal| author=Lal V, Sahota P, Singh P, Gupta A, Prabhakar S| title=Ophthalmoplegia with migraine in adults: is it ophthalmoplegic migraine? | journal=Headache | year= 2009 | volume= 49 | issue= 6 | pages= 838-50 | pmid=19389140 | doi=10.1111/j.1526-4610.2009.01405.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19389140 }} </ref> | * '''Ophthalmoplegic migraine:''' [[oculomotor nerve palsy| Third nerve palsy]], with ocular muscle [[paralysis]] and [[ptosis]], including or sparing the [[pupillary response]]<ref> name="pmid19389140">{{cite journal| author=Lal V, Sahota P, Singh P, Gupta A, Prabhakar S| title=Ophthalmoplegia with migraine in adults: is it ophthalmoplegic migraine? | journal=Headache | year= 2009 | volume= 49 | issue= 6 | pages= 838-50 | pmid=19389140 | doi=10.1111/j.1526-4610.2009.01405.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19389140 }} </ref> | ||
==References== | ==References== | ||
Revision as of 16:37, 7 February 2014
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Migraine Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Migraine physical examination On the Web |
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American Roentgen Ray Society Images of Migraine physical examination |
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Risk calculators and risk factors for Migraine physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The majority of patients with headaches complaints have a normal physical and neurological examination.
Physical Examination
Appearance
The patient appear with a headache.
Vital signs
Eye
- Conjunctival injection may be present
Neurologic
- Horner's syndrome [1] may be present
- Adie type pupil [2] may be present
Head and neck
- Cranial/ cervical muscle tenderness may be present
- Listen for bruit at neck and head for clinical sights of arteriovenous malformation.
Warning Signs
Signs that suggest a more serious cause of headache:
- Systemic symptoms (ie. myalgia, fever, weight loss, scalp tenderness, jaw claudication) and
- Focal neurological signs or
- Confusion, seizures or
- Any impairment of level of consciousness
Focal neurological signs that occur with the headache and persist temporarily after the pain resolves suggest a migraine variant:
- Basilar type migraine: dysarthria, vertigo, tinnitus, diplopia, ataxia, decreased level of consciousness, simultaneous paresthesias[4]
- Ophthalmoplegic migraine: Third nerve palsy, with ocular muscle paralysis and ptosis, including or sparing the pupillary response[5]
References
- ↑ name="pmid17204927">Murphy MA, Hou LC (2006). "Recurrent isolated horner syndrome". J Neuroophthalmol. 26 (4): 296. doi:10.1097/01.wno.0000249324.19486.2a. PMID 17204927.
- ↑ name="pmid21510238">Tafakhori A, Aghamollaii V, Modabbernia A, Pourmahmoodian H (2011). "Adie's pupil during migraine attack: case report and review of literature". Acta Neurol Belg. 111 (1): 66–8. PMID 21510238.
- ↑ name="pmid17614229">Hsu DA, Stafstrom CE, Rowley HA, Kiff JE, Dulli DA (2008). "Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil". Brain Dev. 30 (1): 86–90. doi:10.1016/j.braindev.2007.05.013. PMID 17614229.
- ↑ name="pmid15039036">Schoenen J, Sándor PS (2004). "Headache with focal neurological signs or symptoms: a complicated differential diagnosis". Lancet Neurol. 3 (4): 237–45. doi:10.1016/S1474-4422(04)00709-4. PMID 15039036.
- ↑ name="pmid19389140">Lal V, Sahota P, Singh P, Gupta A, Prabhakar S (2009). "Ophthalmoplegia with migraine in adults: is it ophthalmoplegic migraine?". Headache. 49 (6): 838–50. doi:10.1111/j.1526-4610.2009.01405.x. PMID 19389140.