Headache and Stiff Neck Symptoms Quiz

Physical Examination of Head and Neck

• Objectives:
  • Review anatomy and physiology of the head and neck
  • Review patient history (present, past, family, and social)
  • Outline examination techniques (inspection, auscultation, palpation, percussion)

Anatomy & Physiology

• Skull: Composed of 7 bones (2 frontal, 2 parietal, 2 temporal, 1 occipital)
• Facial Skull Cavities: Eyes, nose, mouth
• Facial Bones: Frontal, nasal, zygomatic, ethmoid, lacrimal, sphenoid, maxillary bones, mandible
• Cranial Nerves: V and VII
• Major Artery: Temporal artery
• Salivary Glands: Parotid (anterior to ear, above mandible), submandibular (medial to mandible), sublingual (anterior, floor of mouth)

Neck

• Structure: Cervical vertebrae, ligaments, sternocleidomastoid and trapezius muscles
• Posterior Triangle: Formed by trapezius, sternocleidomastoid muscle, clavicle, and posterior cervical lymph nodes
• Anterior Triangle: Formed by medial border of sternocleidomastoid muscles, mandible, and midline
• Additional Structures: Hyoid bone, cricoid cartilage, trachea, thyroid, anterior cervical lymph nodes, common carotid artery, internal jugular vein

Neck - Anatomical Review

• Includes various muscles and nerves (images included)

Neck - Lymphatic Glands

• (Diagram included showing location and types of lymphatic glands)

History of Present Illness

• Head Injury: Independent observer's account of the event, state of consciousness immediately and 5 minutes after, duration of unconsciousness(combative, confused, alert, or dazed), underlying predisposing factors (seizure disorder, hypoglycemia, poor vision, lightheadedness)
• Associated Symptoms: Head or neck pain, laceration, altered LOC, changed breathing pattern, blurred or double vision, discharge from ear/nose, nausea/vomiting (N/V), ability to move extremities
• Medications: Prescriptions, over-the-counter

Headache

• Onset: Early morning, daytime, nighttime; gradual or abrupt
• Duration: Minutes, hours, days, weeks, relieved by medication or sleep, spontaneous resolution
• Location: Entire head, unilateral, specific site (neck, sinus, behind eyes)
• Character: Throbbing, pounding, boring, dull, constant pressure
• Severity: Graded 1-10, same or different with each event
• Visual Prodrome: Scotoma, hemianopia, distortion of size, shape, or location
• Other Features: Pattern - worse morning/evening, gradual or abrupt, episodes closer together or worsening, lasting longer, change in level of consciousness as pain increases associated symptoms, nausea, vomiting, diarrhea, photophobia, increase lacrimation, precipitating factors (fever, fatigue, stress, food additives, prolonged fasting), efforts to treat (sleep, pain meds, anticonvulsants, beta-blockers, anti-depressants)

Stiff Neck

• Causes: Neck injury/strain, head injury, swelling of neck, fever, bacterial/viral infection.
• Symptoms: Movement limitation, pain in movement, continuous/cramping pain, radiation pattern (arms, shoulders, hands, down the back).
• Predisposing Factors: Unilateral vision/hearing loss
• Treatment: Heat, pain medication, physical therapy, prescription/nonprescription/alternative or complementary medicine

Thyroid Problem

• Symptoms: Change in temperature preference (clothing relative to family), swelling in neck (interference with swallowing), redness/pain with touch, swallowing or hyperextension of the neck, difficulty buttoning shirts, change in texture of hair, skin, or nails, increased pigmentation of skin at pressure points.
• Other Symptoms: Change in emotional stability (increased energy/irritability, nervousness or increased lethargy/disinterest), increase prominence/puffiness in periorbital area, blurred or double vision, tachycardia/palpitations, change in menstrual flow.
• Treatment: Medications: thyroid preparations, prescriptions, non-prescriptions, alternative or complementary

Past Medical History

• Conditions: Head trauma, subdural hematoma, recent lumbar puncture, therapy around the head/neck, headaches (migraine, vascular), surgery, thyroid dysfunction, thyroid surgery.

Family History

• Conditions: Headaches (types, character, similarity to patient's), thyroid dysfunction

Personal and Social History

• Employment: Risk of heat injury, use of helmets, exposure to toxins/chemicals
• Stress: Tension, demands at homework or school
• Potential Injury Risk: Participation in sports, handrails available, unsafe environment
• Nutrition: Recent weight gain/loss, food intolerances, eating habits.
• Substance Use: Alcohol, street drugs

Examination of the Head - Inspection

• Posture/Facial Features: Upright posture and still position, should be inspected for shape and symmetry with rest, movement, expression. Note asymmetry if present (affect entire face or just a portion); any change in shape, edema, or puffiness; check head size, shape, and symmetry
• Scalp: Check systematically for lesions, scabs, and tenderness.

Palpation (Head/Neck)

• Skull: Palpated in gentle rotary movement progressing systematically (front to back). Check for symmetry, smoothness, and absence of tenderness, swelling, or depression.
• Hair: Palpate texture, color and distribution. Check for smooth symmetry, absent split/cracked ends.
• Temporal Arteries: Palpate and note course.
• Temporomandibular Joint (TMJ): Check space bilaterally.
• Salivary Glands: Check symmetry and any enlargement.
• Percussion: Only performed if sinusitis is suspected
• Auscultation: Only performed if a vascular anomaly is suspected.

Examination of the Neck - Inspection

• Neck: Usual position, slight hyperextension, while swallowing; look for symmetry of sternocleidomastoid/trapezius muscles, trachea alignment, landmarks of triangles, subtle fullness of base of the neck. Note masses, webbing, excess folding, unusual shortness, or asymmetry
• Jugular Vein/Carotid Arteries: Note any distention
• Range of Motion (ROM): Check head and neck movement; smooth and painless ROM.

Palpation (Neck)

• Trachea: Palpate for midline position, compare left vs right space between trachea and sternocleidomastoid muscle.
• Cartilages (hyoid, cricoid, thyroid): Palpate for smoothness, non-tenderness, and motion during swallowing.
• Lymphatic Nodes: Inspect and palpate all nodes in the neck
• Thyroid Gland: Inspect, palpate, and auscultate for symmetry, size, shape, configuration, consistency, tenderness, and nodules.

Test your knowledge on the common symptoms associated with headaches and stiff necks. This quiz explores how factors can exacerbate headache pain and where neck pain might radiate. Additionally, it highlights suggested treatment options for stiff necks.