Clinical examinations in headache

1. Big picture

The clinical examination of a headache patient has one main purpose:

To decide whether the headache is a primary headache, such as migraine, tension-type headache, or cluster headache, or whether it is a secondary headache caused by a dangerous disease.

Most headache patients have benign primary headache, but the examiner wants you to actively search for signs of:

• Subarachnoid hemorrhage

• Meningitis or encephalitis

• Intracranial tumor or abscess

• Raised intracranial pressure

• Cerebral venous sinus thrombosis

• Giant cell arteritis

• Acute glaucoma

• Cervical artery dissection

• Hypertensive crisis or posterior reversible encephalopathy syndrome

• Head