Neurological Evaluation and Workup

A neurological evaluation or examination consists of a series of simple tests that allow your provider to assess your brain and nerve function. Any unusual findings on the neurological evaluation may indicate a need for further diagnostic neurological workup, including computerized tomography (CT) scan or magnetic resonance imaging (MRI).

It's important to note that these tests can't confirm a diagnosis of migraine, but they can help to rule out disease-based causes of head pain in patients with daily or almost daily headache pain.

The Neurological Evaluation

A complete neurological exam should include the following:

  • Mental status assessment: Your doctor will ask you questions to assess speech, memory, comprehension, abstract reasoning, and orientation to environment (i.e., awareness of time and place).

  • Cranial nerve tests: There are twelve cranial nerves that control vision; hearing; taste; smell; pupil reactivity to light; tongue and lip movement; gag reflex; and sensation in the face, head, and neck. A variety of different exams are used to assess these functions.

  • Motor system: Assessment of muscle strength and tone. The doctor will also look for any involuntary twitches or tremors.

  • Sensory system: The use of pain, pressure, temperature, and position to check for loss of sensation. Sensory tests are used on the hands, feet, face, and trunk. The pain test isn't as bad as it sounds; the physician takes a pin and touches it lightly to the skin to determine if you can feel it. Your doctor may also use a blunt object to trace letters or numbers onto your palm and ask you to identify them.

  • Deep tendon reflexes: This is the familiar rubber hammer reflex test. The hammer triggers nerve stimulation that causes muscles to contract, causing involuntary movement. If the movement doesn't occur, it indicates a signaling problem in the nerve pathways.

  • Fact

    Your neurological exam may include a check for plantar reflex. In this test, the doctor firmly strokes the sole of the foot from heel to ball, which should cause the toes to flex or curl downward. If the toes separate and extend out instead, this is called a positive Babinski sign, and it could indicate some form of a brain or spinal cord problem.

  • Coordination: Coordination tests may include alternately touching one's nose and a fixed object; tapping fingers and/ or toes together in a specific pattern; or touching the heel of one foot to the opposite knee and running it down and then back up the shin. These tests can reveal signaling problems in the coordination pathways of the brain.

  • Gait: Gait is an assessment of your walking stance and step. Walking actually requires a fairly complex integration of brain and muscle signals, so it is a good tool to uncover neurological problems. Your doctor may ask you to walk in a number of different ways, including toe-to-heel, toe walking, or completing a series of turns, and will assess your stance, posture, and balance as you walk.

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