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Internal Medicine
5. Extra cranial lesions
Paranasal sinusitis
Dental problems
Ear problems
Ocular problems
Cervical problem
Evaluation of patients presenting with Headache
When evaluating a patient with headache, the goal is to:
Distinguish serious headache from benign headache syndrome
Give appropriate treatment.
Appropriate History is critical in evaluating a patient with headache.
Characterize the headache: the quality, location, duration, time course, the conditions
that produce, exacerbate or relieve it should be reviewed.
Look also for associated symptoms, medication history and psychiatric history.
Physical Examination: is important to search for underlying serious illnesses. It should include
Vital signs (Blood pressure, temperature)
Head and neck examination: scalp tenderness, sinus tenderness, examination of the
oral cavity and tempromandibular joint.
Ophthalmologic evaluation including : fundoscopic examination pupillary size,
corneal clouding
Systematic evaluation of other systems (Glands, chest, CVS, abdomen, GUS, MSS,
and Integumentary system)
Neurological examination including change in mental status, focal neurological deficit,
neck stiffness and other meningeal signs
Diagnosis of common primary headache syndromes is clinical. No specific test is
Occasionally investigations including Neuro-imaging studies are important if the
headache is atypical or it is associated with abnormalities on physical examination.
After appropriate evaluation of the headache the following clinical features should be considered
as indicators of serious underlying disease.
1. First severe headache ever described as the worst type of headache in the patient’s life
may suggest subarachnoid hemorrhage