Headache OSCE

Anamnesis
Time: onset, frequency, pattern, duration
Characteristic: intensity, quality, site, spreading, associated symptoms
Course: trigger factor, aggravating factor, risk factor, family history
Response: what patient do, how it affect daily life, medicine, state of health between
attack, fear/ anxiety of recurrent
Risk Factor: smoking, alcohol, execise, diet

Physical Examination
1. vital sign
2. extra cranial structure evaluation
a. sinusitis
b. scalp superficial temporal artery tenderness
c. cervical paraspinal muscle stiffness
3. fundoscopy check presence of papiledema
4. cranial nerve examination
i. N II: Snellen chart
ii. N III, IV, VI: confrontation, pupil response
iii. N V: clench teeth, open jaw, corneal reflex
iv. N VII: smile + show teeth, close eye, facial symetry
v. N IX: menelan
vi. N XII: julur lidah
5. Brudzinski Neck, Brudzinski contralateral, (Reciprocal Brudzinski), Kernig
Brudzinski Neck flex the neck, see whether the leg will flex.
Brudzinski Contralateral leg flex one leg at the knee, see whether the other leg will flex
Brudzinskis reciprocal contralateral leg-flexion of one hip and knee; extension of another hip and knee; positive if
lower flexion knee, the extension one will flex
Kernig attempt to extend patient leg at knee level after flexing the tight at right angle. Fail to extend the knee
(not more than 135)

6. Neuromotor examination (examiner try to resist all patient movement)

- Patient can resist motor power 5
- Patient cannot resist but can raise up on their own motor power
3
 Upper Extremities
1. Deltoidask patient to raise both arm
2. Test lower arm(biceps) flexion ask patient to flex their elbow
3. Test tricpes muscle ask patient to extend their elbow
4. Ask patient to extend their wrist
5. Test finger flexion ask patient to hold your second finger in their fist tightly.
6. Test finger abduction ask patient to fan out/abduct their finger, but examiner try to compress/close them
back
7. Test thumb opposition ask patient to touch the tip of thumb to tip of little finger

Lower Extremities
1. Hip flexion ask patient to raise their leg.
2. Adduction of hip ask patient to bring both leg together
3. Abduction of hip ask patient to move their leg apart
4. Hip extension ask patient to press down on your hand which is placed underneath patients thigh
5. Knee extension flex the knee first, then ask patient to extend the knee/kick out
6. Ham stringfloe the knee first, ask patient to pull their lower leg towards their buttock
7. Ankle dorsiflexion ask patient to pull their foot up
8. Ankle plantar floexion -- ask patient to press down their foot
9. Extensor hallucis longus ask patient to move the toes up towards their face

7. Pathologic reflex: Hoffman, Tromner, Babinski

Hoffman: Snap the nail of middle finger from above direction nail
Tromner: tap the volar surface of middle finger from the below direction
Babinski: make a smoothe J stroke, from lateral sole to medial sole

Red flags potential secondary headache (refer for CT scan)

-new or different headache in a patient aged over 50;
-Worst headache ever
-thunderclap onset (abrupt and severe);
-Subacute-progressive over month
Keep in mind to screen for
-abnormal neurological signs;
all these during amanmesis!!
-postural;
-valsalva headache
-Seizure
-Symptoms of systemic illness: fever, history of HIV, cancer