What is included in the physical exam to evaluate pediatric headache?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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A thorough physical examination often can exclude systemic causes of headache. Attention should be paid to vital signs, especially the presence of fever, elevated blood pressure, or bradycardia. Search the skin for rashes or cutaneous lesions (eg, petechiae, purpura, ash-leaf spots, café-au-lait spots).

A thorough neurologic examination should be performed to assess the level of consciousness and to evaluate cranial nerve dysfunction, hypertonia, hyperreflexia, hemiparesis, or hemiplegia. Also look for nuchal rigidity, and check the head for hematomas or other signs of trauma. Perform funduscopic examination, looking for papilledema or subhyaloid hemorrhage. Other findings can include the following:

  • Migraine headache - Most children with migraine headaches have a normal physical examination without focal deficits; some children with complicated migraine, however, may have focal neurologic abnormalities, such as weakness, third-nerve palsy, or ataxia.

  • Tension headache - The physical examination findings are usually normal, but pain on palpation of the posterior neck muscles may be noted

  • Sinus headache - Physical findings include pale, edematous nasal mucosa; boggy turbinates; clear or yellow nasal discharge; pain on palpation of frontal or maxillary sinuses; and failure of these sinuses to transilluminate

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