04/09/2026
The Art of the Subjective Examination
Traditionally, a subjective examination is taken to arrive at a diagnosis, but what does a diagnosis actually tell us? In primary headache, a diagnosis is based on a set of signs and symptoms; it doesn’t tell us what’s actually driving the presentation.
The starting point is always the person, not the pathology; validating their experience and building rapport is paramount.
From there, if the subjective examination begins by mapping the behaviour of the head pain, cervical relevance can be established within three minutes in the vast majority of patients.
History-taking is also ‘king’ when it comes to screening for red flags, since primary headache symptoms can closely mimic more serious underlying conditions.
Then there are the reassessment features. Progress tracking relies heavily on subjective features: frequency, intensity, duration, given how few objective physical measures exist for headache.
Finally, as with any musculoskeletal assessment, the broader picture is explored: general health, unexplained weight loss, and other miscellaneous but essential lines of questioning.
Followed as a structured sequence rather than an open-ended conversation, this process captures all seminal information within 20 minutes, regardless of how long or complex the history appears.
