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As well as at other diseases, at pains in a face it is important to investigate in detail the patient, including to estimate the arterial pressure, pulse to exclude arterial hypertension and a feverish state. Certain information is given by supervision over the patient. The patient with an epileptiform neuralgia can cover the face and not allow to touch a trigger zone.
It is necessary to examine each square millimeter mucous upper respiratory tracts and a mouth not to pass a malignant tumor, especially at the elderly men abusing tobacco and alcohol. It is necessary to examine area of the head and neck for detection of asymmetry and hypostasis. The neck is palpated in search of volume educations, check a pulsation of arteries and existence of noise over them. Carefully investigate function of cranial nerves, negligence can lead to the admission of symptoms of an organic disease. The patient needs to be asked whether he noticed changes of sense of smell and to check sense of smell objectively by means of coffee or other aromatic substance. Eyeballs are palpated for detection of morbidity or pathological density. Make-shifts investigate fields of vision, examine an eyeground and register reaction of pupils to light. Function of muscles of an eyeglobe is estimated, having asked the patient to look in all directions. Function V of pair of cranial nerves is estimated by a pricking of face skin. The lid reflex is checked by means of a cotton wool piece, the sneezing reflex is caused, entering a wadded flagellum into a nose. Force of masseters is determined by a palpation. Function VII of pair of cranial nerves is estimated on ability of each face zone to make autokinesias. The flavoring perception is estimated, wiping lateral surfaces of language with the tampon moistened with solution of sugar or salt, and the patient has to estimate flavoring feelings at the language which is put out outside. The hearing is estimated by means of a tuning fork, however, if the patient complains of a ring in ears or decrease in hearing, it is necessary to carry out a full audiometriya. It is also necessary to investigate function VIII of a cranial nerve not to pass the neurinoma of an acoustical nerve irritating a trifacial. Vestibular function is checked by means of ice water, entering from 1 to 3 ml into outside acoustical pass under control of sight at a ducking at an angle 30 ° to the horizontal plane, and contact of water with a tympanic membrane has to make not less than 20 sec. Normal at the patient the horizontal nystagmus in the direction opposite to the studied ear develops. Before investigating the second ear, it is necessary to wait not less than 5 min. The gag reflex is checked, stimulating a back wall of a throat. Perform inspection of a throat by means of mirrors for an assessment of function of phonatory bands. Function XI of pair of cranial nerves is checked on the movement of a trapezoid and grudinoklyuchichno-mastoidal muscle. And, at last, function XII of pair of cranial nerves is checked, having asked the patient to put out tongue and to move him to the left, at the same time fingers of the doctor show resistance.
For illumination of a nasal cavity, a mouth, a throat and a throat use a frontal mirror or a lamp. It is necessary to examine mucous nasal cavities. In case of its hypostasis for simplification of research it is possible to use one of vasoconstrictive drugs locally. In a nasal cavity it is possible to find volume educations, a purulent discharge and sharp curvatures of a nasal partition. The nasopharynx is examined by means of a mirror or angular lenses to glance for a palatine velum. The throat and a throat are also investigated by means of a mirror. All painful zones need to be palpated carefully for detection of volume education or inflammatory process.
The patient should conduct only those researches which can exclude or confirm the suspicions which arose when collecting the anamnesis and clinical examination. All patients need to make clinical blood test, biochemical analysis of blood, to determine the level of electrolytes in plasma in and a blood sedimentation rate, and also a X-ray analysis of bone bosoms and teeth. If after all these manipulations the diagnosis is not established, it is necessary to carry out a computer tomography of the head. After an exception of anatomic pathology at diagnostic inspection it is necessary to make an attempt of trial treatment by various drugs to establish the diagnosis: for example, some cases of migraine are difficult to be diagnosed, however they quickly react to therapy by one of the drugs containing ergotamine.