Head Assessment

Types of Headaches

Assessment Techniques

Abnormal Findings

Head Injuries

Inspect and palpate the skull

Have you experienced any head injury or head trauma?

Associated Symptoms:

Deformities

Lumps, depressions, or abnormal protrusions

Migraine

Cluster Headaches

Is the skull round and symmetric?

Is the skull of appropriate size related to the patient's body size?

Macrocephaly: abnormally large head.

Microcephaly: abnormally small head.

Crepitus or tenderness

Assess hair/facial hair for baldness or infestation.

Are there any masses or indentations?

Palpate temporal artery

Test Cranial Nerves

Palpate temporomandibular joint

Palpate sinuses

Inspect Eyes

Tension Headaches

Occipital or Frontal

Bandlike tightness

Supraorbital, retroorbital, or frontotemporal

Produce pain around the eye, temple, forehead, and cheek.

Inspect Ears

Unilateral pain

Viselike pain

Throbbing/pulsating pain

Pain is often severe

Pain is often excrutiating

Inspect Nose

Occur about twice per month; lasting 1-3 days.

Occur 1-2 times per day; lasting 1.5-2 hours

Precipitating factors may include alcohol ingestion, daytime napping, wind or heat exposure.

Precipitating factors may include alcohol, stress, menstruation, and eating chocolate or cheese.

Associated symptoms may include: nausea, vomiting, and visual disturbances

Associated symptoms may include: eye reddening, tearing, eyelid drooping, rhinorrhea, and nasal congestion

Assess for skin breakdown

Are you experiencing any neck pain or stiffness?

When and how did the injury happen?

Where were you when the injury happened?

Were you wearing a helmet or hard hat?

Have you experienced any vision changes?

How did you feel just before the injury? Did you have a seizure?

Did you lose consciousness prior to or as a result of the injury?

Where did you hit your head?

How long were you unconscious?

Since the injury, are your symptoms better or worse?

Did you feel any symptoms after the injury?

Ear or nose discharge?

Precipitating factors may be anxiety, stress, posture, and depression.

Associated with family history of migraine.

Facial

Asymmetry with central brain lesion or peripheral cranial nerve VII damage.

Edema around eyes and cheeks

Inspect Mouth

Tense rigid facial muscles

Pain is often mild to moderate, diffuse, dull, and aching.

Musculoskeletal origin

Pediatric

Hydrocephalus

Down Syndrome

Plagiocephaly

Atopic (Allergic) Facies

Craniosynostosis

Often relieved by laying down, dark room, sleep, taking an NSAID early, and avoiding opioid

Often relieved by massaging muscles in the area, rest, and NSAID medication

Often relieved by movement and pacing

Fetal Alcohol Syndrome

Abnormal Facies with Chronic Illness

Acromegaly

Cushing Syndrome

Bell Palsy

Stroke

Parkinson Syndrome

Cachectic Appearance: wasting diseases

Assess for facial symmetry

Involuntary movements