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INVESTIGATION OF HEADACHES: PHYSICAL EXAMINATION
The physical examination can include a general examination of all the body’s systems, e.g. the pulse is taken, the heart listened to, blood pressure measured, and the abdomen felt. In a full neurological examination, the cranial nerves are tested one by one. The ability to smell may need to be tested. It is important to test vision, especially visual acuity and visual fields. The ophthalmoscope is an instrument designed so that the doctor can look at the optic nerve and the blood vessels at the back of the retina; its use is particularly important in certain cases. Movements of the eye, facial muscles, soft palate, and shoulder movements are tested as are sensation on the face and hearing.
The power of the muscles and sensation in the rest of the body is then tested as are fine movements and co-ordination. The reflexes are tapped to see if they are equally brisk on each side and the sole of the foot scratched: a down-going toe in response to this is normal. At some stage the doctor will listen over the neck, head, and eyes for any murmurs, noises caused by turbulence in blood flow produced by narrowing or malformations in blood vessels.
In most cases of headache, the examination is negative, suggesting that all is well but, occasionally, a small change may alert the doctor to the possibility of a more serious problem and it is then that the patient may be referred to the specialist for investigations.
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