Which findings on neurological exam suggest migraine headache?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Although a thorough screening neurologic examination is essential, the results will be normal in most patients with headache. Evidence of autonomic nervous system involvement can be helpful, although most patients with migraine exhibit few or no findings. Serial neurologic examinations are recommended.

Possible findings during a migraine include the following:

  • Cranial/cervical muscle tenderness

  • Horner syndrome (ie, relative miosis with 1–2 mm of ptosis on the same side as the headache)

  • Conjunctival injection

  • Tachycardia/bradycardia

  • Hypertension/hypotension

  • Hemisensory or hemiparetic neurologic deficits (ie, complicated migraine)

  • Adie-type pupil (ie, poor light reactivity, with near dissociation to light)

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