Your initial visit to the physician for evaluation of headache should involve a thorough neurological evaluation. Such examinations are complex and somewhat difficult for the lay person to understand. Most of the tests that are part of this examination may seem silly to the patient, but they do have their well-founded purposes.

The physician first will test your ability to deduce and comprehend language, and he/she also will evaluate your intellectual function, memory and mood. Much of this the physician can assess while taking your medical history. The physician will examine your eyes with an ophthalmoscope, looking at the optic nerve (which leads from the back of your eye to the brain) and the blood vessels surrounding that nerve; this area provides an actual window into the brain, and by examining the eye with an ophthalmoscope the physician can determine whether the pressure within your head is normal or increased. The pupils are examined and observed for their reaction to light. The physician will note how your eyes move when you are asked to gaze in different directions. The symmetry of the face and tongue and their movement is checked, along with facial sensation. The physician may look into your throat and make you gag slightly with a tongue depressor (this is not particularly fun). He/she then will examine your muscle strength and check the reflexes in your arms and legs. The physician will search for disturbances in the sensory system by observing your reaction to stimuli applied to the skin, your ability to detect slight movements of the toes and your ability to detect vibration. He/she will test your coordination and your ability to walk. The physician may check for tenderness over your sinuses or specifically examine the temporomandibular joints as you open and close your mouth. He/she may examine the arteries of the neck and temples and the muscles of the neck and shoulder regions.

You would be amazed to know how useful these simple tests can be in determining which patients require further testing.