Topic Overview

A careful physical exam is needed to make sure the nervous system is working normally and to discover clues about the cause of a person's headaches. Results of the exam can help determine whether further testing is needed.

During the physical exam, the doctor will:

• Check your temperature. If you have a fever, your headache may be caused by an infection.
• Check your blood pressure.
• Examine and feel your head for any evidence of injury or painful areas (trigger points).
• Examine inside your eyes for signs of bleeding and increased pressure inside the eyes or head.
• Examine your nose and ears for signs of infection.
• Examine your neck and throat for swollen or tender glands, muscle spasms, and stiffness or limitation of movement.

When the doctor checks your nervous system, he or she will:

• Check your mental status. The doctor will check to see whether you appear confused or disoriented in some way or function at a lower level than expected.
• Evaluate your senses. The doctor will evaluate your speech, eye movements, tightening (constriction) of the dark spot in the center of your eye (pupil), eyesight, hearing, facial movements, and sensation.
• Evaluate your balance. The doctor will check your balance by asking you to stand with your eyes closed. He or she will also ask you to walk in order to evaluate your balance and coordination. You may be asked to repeatedly touch your finger to your nose.
• Evaluate your muscle strength and nervous system reflexes. The doctor will check the strength of movement in your arms and legs and other parts of your body. He or she will also check your nervous system reflexes with a slight tap of a special instrument (percussion hammer).

During the physical exam, the doctor may decide to examine other parts of your body to look for possible causes of the headaches. The doctor may also ask about other health problems if he or she thinks your headaches are related to another medical condition.

If you are having a headache during the exam, the doctor may notice things that often occur with a specific type of headache:

• The head or neck muscles may be tight and tender.
• The neck may be stiff and may not move in all normal directions.
• There may be areas of tenderness and spasm (trigger points).
• You may seem anxious or depressed.
• Muscles around the jaw may be tender if myofascial pain dysfunction of the jaw muscles is present.

Any abnormal results in the physical exam may suggest a possible medical cause of headaches. Abnormal results may include:

• Fever, which may point to an infection, such as sinusitis. A headache with a fever, a stiff neck, nausea, and vomiting may point to meningitis, encephalitis, or a brain abscess.
• A headache that began suddenly in a person who has not had headaches before, or a dramatic change in an established headache pattern.
• A headache that follows any form of physical exertion, such as exercise, sexual activity, coughing, or bending (these types of headaches usually are not caused by a serious problem, but in some cases they can be caused by an aneurysm).
• Abnormal speech, eye movements, walking, coordination, or reflexes.
• Abnormal eye exam, which means there may be increased pressure inside the head.
• High blood pressure.
• Other findings, such as arthritis, that may suggest autoimmune disease.