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.
Signs of Migraine Variants
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]
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
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.