This can indicate teeth grinding or clenching related to anxiety or TMJ dysfunction which can be a source of headache. Assessing for any jaw asymmetry, jaw clicking or discomfort by palpating the TMJ.Motor system: You assess the motor system by looking at the strength and tone of muscle groups, looking for asymmetry, atrophy, abnormal movements, or pain with movement, and any baseline changes over time. Fundoscopic eye exam: looking for clear optic disk margins, intact light reflexes, normal venous pulsations, assessing for papilledema indicating increased ICP.Assessing for facial pain within trigeminal nerve distribution, leading to a diagnosis of trigeminal neuralgia or atypical facial pain.

Assessing facial movements for symmetry and differences, assessing tongue movement (dysarthria, dysphagia), which can indicate developmental anomalies.

This tends to be more bothersome in high school/college age students, mainly because they have a lot of reading to do. Convergence insufficiency can be treated by specific eye exercises/therapy or glasses. Inability to cross the eyes can have a negative effect, especially with balance or reading, leading to eye fatigue and blurry vision.

Assessing eye movements, being especially aware of any nystagmus or convergence insufficiency.

This is documented as sensitivity within the distribution of the nucleus caudalis, and a common finding in migraine.

Assessing trigeminal distribution, making note of an increased level of sensitivity (prickly, tickly or discomfort) as you move laterally across cheek to above their ears with a pointy object.

If their occiput is painful, there may be neuralgia related to tension-type headaches. It would not be uncommon for a patient with chronic headache to report discomfort having their scalp even lightly palpated and then to report it hurts to brush their hair (central sensitization).

Assessing any scalp sensitivity: this may indicate any occipital nerve irritation, or central sensitization often seen in chronic headache/migraine.

A few assessments have implications for headache, such as: On the formal exam, you assess the function of the 12 cranial nerves by having them do a few maneuvers, checking out their eyes with the ophthalmoscope.

You assess their hearing and speech, watch their facial and head movements. Are they reporting any anxiety or depression, cutting, suicidal ideation, school avoidance? Are worries getting in their way at school, at home or with friends? We know there is a connection between headache and mental health challenges and need to address what they report and what we perceive.Ĭranial nerves: Assessing the cranial nerves is done both formally and informally during the visit. Another important finding is their mental health status.Often they do not recognize this until I ask and are relieved to know it could be a medication side effect. I usually ask if they are having any trouble with memory, or unexpected school difficulties. This is a little tricky to ascertain, most teens do not know what mental clouding means. One finding to think about is any side effect of medications many of our daily medications can cause mental clouding, even in the smallest of doses.In general, the child or teen with headache are alert and aware, conversant about a variety of topics, and age-appropriate, unless there is an underlying developmental delay or challenge, such as autism. Attention also needs to be paid to achievement of appropriate developmental milestones. You assess whether they are dressed appropriately, have good hygiene and assess their mood and interactions. The patient will answer questions about school and life, general functioning, any social concerns. Mental status: This part of the neuro exam is done throughout the visit. Much of the exam can be done during the visit, prior to the formal exam, by interacting, observing and listening to the patient. These components include: mental status, cranial nerves, motor system, sensory system, deep tendon reflexes, coordination and the cerebellum, and gait. The neurologic exam is divided into several components, focusing on different parts of the nervous system. The nervous system is a complex network of fibers, woven throughout the entire body and responsible for both simple and complicated human functions. I will review a typical neuro exam and share some clinical pearls in this post. There are certain findings which are common among patients with headaches, some notable particularly for migraine. But I always do a mostly a neurological focused physical exam.

Really, this is the most important part of the visit. Whenever I see a patient in my office, I spend most of the visit talking, getting to know the patient and family and getting a thorough history.

Pnp neuro exam