Rodolfo T. Rafael,MD.
| In taking the history, inquire carefully for the attributes of pain (PQRST): provocative and palliative factors, such as position of the head and body, coughing, straining, emotional tension; quality, whether burning, aching, deep or superficial, throbbing or continuous; region of the head involve: severity of the pain; and timing. The last includes the duration of the history and the periodicity of symptoms. Seek associated symptoms: nausea and vomiting, constipation or diarrhea, diuresis, rhinorrhea; visual disturbances, such as photophobia, scotoma, tearing, diplopia; cerebral symtoms, such as aura, paresthesias, anesthesias, motor paralysis, vertigo, mood, sleep disturbances. Inspect the skin and scalp for bulges and areas of erythema. Withdeep pressure palpate the bones of the cranium and face for tenderness and irregularities of contour. Especially, pinch the muscles in the nape of the neck and the upper borders of the trapezii for unusual tenderness. Palpate the carotid and temporal arteries for pulsations and tenderness. Examine the eyes for pupillary irregularities, conjunctival injection, abnormal extraocular motion; use the confrontation test to detect gross defects in the visual fields; look with the ophthalmoscope for choked disk and retinal hemorrhages. With the stethoscope auscultate the cranium for bruits. Make a routine neurologic examination with special attention to the cranial nerves and the deep tendon reflexes.
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