Patients can have multiple complaints. These complaints, referred to as “symptoms,” are the main focus of the medical evaluation. This is why the most important issue when a patient is visiting the doctor may not be what a previous MRI or CAT scan or any particular test reveals but, rather, what actually bothers the patient. Then, after taking the patient’s history, the physician determines whether the patient’s symptoms do or do not relate to the findings on examination or testing.

Many times, patients have complaints that have nothing to do with their tests. For instance, a patient may have headaches and a cyst in their brain, but the two may not be related. Although no one should dismiss findings on any particular test, or on an examination (see below), the most important issue is what actually disturbs the patient, and then to be certain how, if at all, the patient’s signs and testing relate to these complaints.

“Signs,” as opposed to “symptoms,” are the objective abnormalities the physician detects on examination. These can include: delineation of weakness, abnormal coordination, abnormal pupil size or response to light, eye movements and other abnormalities. Again, the major issue is to intercalate how the patient’s complaints (i.e., symptoms) relate to the physician’s detection of signs (i.e., objective abnormalities).

A good example is in order. If a tree falls on your roof, you may have broken shingles and a leak from the ceiling. However, the two may not be related—the leak may have nothing to do with the broken shingles but, rather, results from damage to the support system of the gutters or damage to the flashing around the chimney.

Put another way, abnormalities in structure (e.g., broken roof shingles) can be independent of abnormalities in function (e.g., ceiling leak). The same is true in brain disease: an abnormality in structure (e.g., seen on an MRI of the brain) may not relate to abnormality in function (e.g., weakness of the arm).

One of patients’ most common neurological complaints is headache. Headaches can be mild or severe, last seconds, minutes, hours or days, be in different locations on the head and often are quite frightening. Sometimes, these are associated with tingling sensations in the back or front of the head (tingling usually implies neck or facial nerve disorder), and other headaches can be associated with ocular or facial pain.

It is important to note the brain has no pain receptors. That is why Alzheimer’s disease and Parkinson’s disease do not hurt (nor does it hurt to think, a cerebral activity). This is also one reason why brain tumors can be so serious—one does not feel the tumor.

The only pain receptors within the cranial vault are in the covering of the brain (i.e., meninges, infection or irritation of which can cause meningitis) and the walls of arteries, which can swell in migraine or stretch from a tumor or hydrocephalus. Most headaches, such as muscle tension headaches, emanate from the neck region. Cervical compromise can cause headaches—this is one reason why there are head/neck rests on the seats of automobiles: to alleviate flexion/extension cervical compromise in an accident, and decrease risk of headaches and neck injury.