This document provides an overview of evaluating a patient presenting with headaches. It begins with definitions of headaches and classifications of different headache types. It then discusses the etiology, or causes, of headaches which can be primary disorders or secondary to other underlying pathologies. The document outlines the examination process including physical exams of the head, neck, eyes and neurological exams. It details aspects of history taking such as onset, duration, location and character of headaches. It lists potential diagnoses that can be made through tests like blood tests, imaging scans, and spinal taps. Finally it discusses management and treatment options for different headache types as well as general preventative measures.
2. DEFINITION :
Headache is a type of pain or discomfort in the head or neck region
that’s described as a sense of pressure, throbbing, constant, sharp or
dull in nature.
They can vary in intensity, duration and location, and can be
accompanied by other symptoms like: Nausea, Sensitivity to light/sound
and/or dizziness
While most headaches are not dangerous, certain types can be a sign
of a more serious condition
3. CLASSIFICATION:
• There are many different types of
headache, such as (Tension
Headache, Cluster Headaches, Sinus
Headaches, Migraines) and others.
4. ETIOLOGY OF HEADACHE:
• It can be a primary disorder or secondary to pathology.
1) Primary Headache Disorders include:
- Migraine, Tension Type, Trigeminal Autonomic Cephalgias (Includes
Cluster Headaches)
2) Secondary Headache Disorders include:
has numerous causes, ex: Extracranial (Dental Disorders) / Intracranial
(Tumors) / Systemic (Viral Infections) / Medications (Hormone Therapy,
Analgesic Overuse)
and Dehydration.
5. EXAMINATION SEQUENCE:
• Mental Status Higher Function
Cranial Nerve Examination
Motor System Evaluation
Sensory System Evaluation
Reflex Testing
Coordination Test
6. PHYSICAL EXAMINATION OF HEADACHE:
• 1) General Medical Examination: Vital Sign [exam. Fever & blood
pressure]
2) Head & Neck Examination:
*by inspection see if there is any trauma or open wounds
*neck stiffness
*pain and tenderness by percussion or leaning forwards in
(sinusitis)
*examination of the mouth
*examination of TMJ disorder
3) Ophthalmologic Examination: [cluster headache, glaucoma,
7. NEUROLOGICAL EXAMINATION:
• Mental Status Examination: Level of Consciousness
Cranial Nerves:
1) Optic Nerve: to examine pupils and color vision
2) Oculomotor, Trochlear, Abducens : to examine eye movement in all
directions
3) Trigeminal Nerve: to examine facial sensation
4) Facial Nerve: to examine strength of facial movement
5) Vestibulocochlear Nerve: to compare hearing side to side
6) Glossopharyngeal & Vagus Nerves: in conscious patient, symmetrical
elevation of the palate and uvula
7) Accessory Nerve: to examine shoulder shrug
*Motor and Sensory Examination
9. HISTORY TAKING:
Past Medical:
Ear/Eye Infection
(Sinusitis, Intracranial Abscess)
C.A.D (by usage of Nitrates)
Brain Malignancy Metastasis
Past Surgical:
Head Injuries (from few
days/weeks)
Hemorrhage
Family History:
any history of Migraine
Epilepsy
Subarachnoid
Hemorrhage
Drug History:
Allergy, Chronic drug usage (Dose + Side
Effects)
Social History:
Smoking, Caffeine Consumption,
Occupation
10. DIAGNOSIS DX:
• CBC : to exclude Blood Infections
CT Scan / MRI : (for any Trauma or Tumors eg. S.A.H)
Sinus X-Ray : for sinus problems
EEG (ElectroEncephaloGram) : if suspect patient having seizures
Spinal Tap (Lumbar Puncture) : (by taking sample from CSF look
for infection or inflammation in brain or spinal cord)
11. MANAGEMENT:
• According to the type of Headache, General Management
include
Proper Hydration, Magnesium Supplements (block signals from
brain)
Adequate Sleep, Caffeine, avoiding bright light, etc…
1) Migraine Headaches:
Moderate (NSAIDs +
Acetaminophen)
Severe (Triptans 5HT1-Receptor
Agonist)
2) Tension Headaches:
NSAIDs + Acetaminophen +
Diclofenac
4) Cluster Headaches:
Sumatriptans (SSRA) / CCB
(Verapamil)
3) Sinus Headaches:
Antihistamines
(Allergy)
Antibiotics
(Inflammation)
NSAIDs (as Analgesia)
5) Hypertension Headaches:
Aspirin (Considered to be the Safest
Option)
12. PREVENTION:
Making lifestyle changes can help reduce the frequency and
severity of headaches.
These changes can include avoiding triggers, getting regular
exercise, reducing stress and eating a healthy diet.
It is also important to get enough sleep and practice good sleep
hygiene.
Taking breaks from screens and engaging in relaxing activities
can also help reduce stress and prevent headaches.
