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HEADACHES: THE EXAMINATION

Of course, your doctor will diagnose your headaches in a slightly different way, because he or she has the advantage of being able to examine you as well.

However, don’t be misled. Many patients think (wrongly) that the examination tells the doctor everything, and that a diagnosis without one means it’s probably wrong. In fact, almost the reverse is true. With headaches it is mainly careful, painstaking questioning that leads to the most accurate diagnosis. Perhaps your doctor finds out the critical information that the headache came on suddenly, like a blow to the back of the head; or else that the headache comes on if you miss a meal; or, maybe, there’s a background of marital discord or stress at work. It’s a bit like detective work, piecing information together until it all clicks into place.

Having said this, the importance of the physical examination should be stressed, because there are one or two items that your doctor will certainly want to check. What the doctor examines will vary according to the answers you’ve given to the

questions asked. For example, if the history is highly suggestive of sinusitis, then your doctor may only need to press on the bone overlying the sinus to confirm the diagnosis. A thorough examination of the muscles or nerves would be unnecessary. On the other hand, these will need to be examined if your story points towards a slipped disc in the neck.

The sort of examination your doctor gives you depends upon the symptoms and the history. Some or all of the following may be necessary — blood pressure measured, temperature taken, examination of the movements of your neck to see if you can bend your neck properly, not just forwards but also from side to side. You may be examined for trigger spots and painful areas in the muscles of the neck and back, and your spine may be checked. Your doctor may also examine your temples — to discover whether or not there are prominent pulses and tender arteries -investigate the power you can develop in your arms and legs, tap your reflexes, and even tickle the bottom of your feet! (This is a very quick way to tell whether you have had a stroke or a similar brain injury.) Finally, your doctor may look into your eyes, test your pupil reflexes, press against the bones in your face to see if they’re tender, look at your teeth, and check the way your mouth closes.

The combination of history-taking, examination and appropriate prescription may deal with your headaches fully. As we discussed earlier, your response to the treatment is also an important diagnostic pointer. In just a few cases the doctor may be unsure of the diagnosis and under those circumstances will use the resources of the hospital laboratory and X-ray department.

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