The Neuro Exam in Severe Headache

A neuro exam should be part of the assessment of every headache case.

The reason for this is that headache is much more likely to have a serious cause if abnormal neurological examination findings are present.

Another reason to perform a quick neurological examination is to determine whether a lumbar puncture can be performed in someone with suspected meningitis.

When I talk to general physicians and general practitioners I am often asked for a quick neurological exam that will help them screen for important positive and negative findings - that is signs that could make or break a case.

Forbes Quick Neurological Examination

Using Forbes Quick Neurological Examination Intelligently

This is not a tick-box exercise.

You have to be actively thinking about the differential diagnosis and what other signs may help you complete your assessment as efficiently as possible.

In someone presenting with headache you may need to consider the following:

1. Test for nuchal rigidity or neck stiffness
2. The Jolt test for meningeal irritiation
3. Horners Syndrome (carotid dissection)
4. Cranial palpation in the neuralgias
5. A Blood Pressure recording is mandatory, especially in Thunderclap Headache
6. Rash, Ear, nose throat exam in meningitis
7. Sensory examination of the scalp - you may identify sensory change in occipital neuralgia or supraorbital neuralgia