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/Neurology

For patients presenting with a new headache, of which a secondary cause is a possibility (eg. older person with new HA). This is just a screener. It does not list the complete assessment findings for the conditions mentioned, but serves as a reminder of things to look out for in a person presenting with a headache. It does not exclude any differential listed with a 100% certainty.

No features of Greater/Lesser Occipital Neuralgia
(pain not described as sharp/electric/shooting. no trigger points at exit foramina)

No features of dental referred pain
(good dentition, esp to top R molars, no gum/dental tenderness.)

No features of OM or mastoiditis
(no mastoid tenderness, normal light reflex on TM, hearing equal)

No features of cluster HA
(no teariness / facial pain)

No features of typical migraine
(no aura / prodromal symptoms)

No features of glaucoma
iCare Tonometer:
vision 6/6 bilaterally.

No features of Cerebral Venous Sinus Thrombosis (CVST)
no chemosis (conjunctival swelling) no proptosis no lid oedema, no eye pain, Eye movements normal, with no 3rd, 4th or 6th nerve palsies identified.
no risk factors for CVST such as pregnancy / HRT / OCP / thrombophilia / haemochromatosis

No overt signs of raised ICP.
Not exac by lying down.
Not worse when waking up
Not worse on leaning forward and coughing.
No hx Neurosurg / VP shunt
No hx intracranial surgery.
No Signs of IIH
No Loss of peripheral vision
No Tinnitus
No Nausea/vomiting.

No Signs of Carotid/Vertebral artery dissection causing a CVA:
The NIHSS Stroke assessment score is 0. In addition to that, the following statements are true:
No headache.
No neck pain.
No tinnitus
No cervical bruits
No scalp tenderness.
No orbital/monocular pain.
No vertigo
No lightheadedness
Normal light reflex. Normal accommodation reflex. Normal pupils. No visual field defects.
No ptosis. Normal direct and consensual pupillary response. No diplopia. Normal eye movements.
Normal sensation in ophthalmic, maxillary and mandibular trigeminal divisions. Normal corneal reflex.
Normal upper muscles of facial expression. Normal lower muscles of facial expression. Normal taste.
Grossly normal hearing. Normal Rinne’s and Weber’s tests.
Normal gag reflex. Normal tongue movements.
Normal trapezius and sternocleidomastoid function.
*smell assessed with coffee. 128khz tuning fork used.
No lateralizing UL or LL symptoms or signs.
Sensation equal in LL and UL.

As pt is > 65yo, it is noted that there are no features of Giant Cell Arteritis / Temporal Arteritis:
No tenderness over scalp or temporal artery
No Jaw Claudication
No Fever
No Hx PMR or rheumatism.
No visual abnormalities (painless vision loss)
No raised inflammatory markers (ESR/CRP)