Which physical findings suggest a more serious cause of headache other than migraine?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Physical examination findings suggesting a more serious cause of headache include systemic symptoms (eg, myalgia, fever, malaise, weight loss, scalp tenderness, jaw claudication) and focal neurologic abnormalities or confusion, seizures, or any impairment of level of consciousness. On the other hand, focal neurologic findings that occur with the headache and persist temporarily after the pain resolves suggest a migraine variant, as follows:

  • Unilateral paralysis or weakness - Hemiplegic migraine

  • Aphasia, syncope, and balance problems - Basilar-type migraines

  • Third nerve palsy, with ocular muscle paralysis and ptosis, including or sparing the pupillary response - Ophthalmoplegic migraine

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