II. General
- Neurologic deficit suggests Organic Headache
- Organic Headache is unlikely without neurologic deficit
III. Exam: Key Neurologic Assessment
- Complete Neurologic Examination
- Motor Exam (Hemiparesis)
- Sensory Exam (especially Trigeminal NerveSensation)
- Cranial Nerve exam
- Deep Tendon Reflexes
- Coordination and gait (e.g. Ataxia)
- Signs of Meningeal Irritation
- Nuchal Rigidity on Passive neck flexion
- Kernig Sign
- Brudzinski Sign
-
Altered Level of Consciousness
- Causes of Focal neurologic deficits
- Causes of Non-focal neurologic deficits
- Meningitis
- Encephalitis
- Subarachnoid Hemorrhage
- Intracranial Hypertension
- Anoxia
IV. Exam: Other key points
- Vascular examination
- Carotid Bruit
- Temporal artery bruit, firmness, tenderness or pain
- Head and Neck Exam
- Sinus tenderness
- Neck range of motion
- Evaluate for Nuchal Rigidity in Meningitis
- Trapezius Muscle or Sternocleidomastoid Muscle tenderness or spasm
-
Eye Examination
- Pupil reaction
- Visual Fields
- Intraocular Pressure (Narrow Angle Glaucoma)
- Abnormal eye movements (e.g. Nystagmus)
- Funduscopic Examination (e.g. Papilledema)
- Skin Findings suggestive of congenital intracranial neoplasm
- Neurofibromatosis
- Tuberous Sclerosis
-
Vital Signs
- Head Circumference in children
- Tachycardia
- Intracranial lesion (see list below)
- Hypertension
- Hypertensive Headache
- Intracranial Lesion
- Fever
- Meningitis
- Encephalitis
- Viral Syndrome
- Temporal Arteritis
- Acute Sinusitis
V. References
- Cutrer in Goldman (2000) Cecil Medicine, p. 2066
- Duman in Friedman (1991) Medical Diagnosis, p. 392-3
- Henry in Marx (2002) Rosen's Emergency Medicine, p. 152
- Pruitt in Goroll (2000) Primary Care Medicine, p. 931-9
- Tabatabai (2021) Emerg Med Clin North Am 39(1): 67-85 [PubMed]