Migraine physical examination
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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. Signs suggestive of a serious cause of headache, such as systemic symptoms, focal neurological signs, seizures or impairment of the level of consciousness should be ruled out.
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
- 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.