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Diagnosing Your Headache: Headache Evaluation

Why is it important to diagnose a headache?

The correct diagnosis is needed to begin an effective treatment plan. Early visits to your doctor are made to establish what type or classification of headache you have.

Headache history

The most important part of the headache evaluation is the headache history. It is important to describe your headache symptoms and characteristics as completely as possible. Your headaches can be better diagnosed if you can tell your doctor:

  • How old you were when the headaches started
  • How long you have been experiencing them
  • If you experience a single type of headache or multiple types of headaches
  • How often do the headaches occur
  • What causes the headaches, if known (For example, do certain situations, foods, or medicines usually trigger the headaches?)
  • Who else in your family has headaches
  • What symptoms, if any, occur between headaches
  • If your school or work performance has been affected by the headaches
  • If physical activity aggravates the pain
  • What events are associated with the headache

It also helps if you tell your doctor how you feel with the headache and what happens when you get a headache, such as:

  • Where the pain is located
  • What it feels like
  • How severe the headache pain is, using a scale from 1 (mild) to 10 (severe)
  • How long the headaches last
  • If the headaches appear suddenly without warning or with accompanying symptoms
  • What time of day the headaches usually occur
  • If there is an aura (changes in vision, blind spots, or bright lights) before the headache
  • What other symptoms or warning signs occur with a headache (such as weakness, nausea, sensitivity to light or noise, appetite changes, changes in attitude or behavior)
  • How frequently you get headaches

History of headache treatments

A history of prior headache treatments is also an important part of the headache evaluation. Provide your doctor with a history of prior treatments — both prescribed and over-the-counter — for your headaches. Tell your doctor what medicines you have taken in the past and what medicines are currently taking. Don't hesitate to list them, bring the bottles, or ask your pharmacist for a printout.

Studies performed by other doctors, including X-rays and scans, are very important. Bring these to your appointment as well, since it might save time and the need to repeat the tests.

Physical and neurological examinations

After completing the headache history portion of the evaluation, the doctor will perform a complete physical and neurological examination. The doctor will look for signs and symptoms of an illness that might be causing the headaches, such as:

  • Fever or abnormalities in breathing, pulse, or blood pressure
  • Infection
  • Nausea, vomiting
  • Changes in personality, inappropriate behavior
  • Mental confusion
  • Seizures
  • Loss of consciousness
  • Excessive fatigue, wanting to sleep all of the time
  • High blood pressure
  • Muscle weakness, numbness, or tingling
  • Speech difficulties
  • Balance problems, falling
  • Dizziness
  • Vision changes (blurry vision, double vision, blind spots)

Neurological tests focus on ruling out diseases that might also cause headaches, such as epilepsy, multiple sclerosis, and other cerebrovascular diseases. A structural disorder of the central nervous system, as listed below, might be suspected in the development of serious headaches:

  • Tumor
  • Abscess
  • Hemorrhage (bleeding within the brain)
  • Bacterial or viral meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
  • Pseudotumor cerebri (increased intracranial pressure)
  • Hydrocephalus (abnormal build-up of fluid in the brain)
  • Infection of the brain
  • Encephalitis (inflammation of the brain)
  • Blood clots
  • Head trauma
  • Sinus blockage or disease
  • Malformation (such as Arnold-Chiari)
  • Injuries
  • Infections, such as Lyme disease
  • Meningitis
  • Aneurysm

Psychological evaluation

An interview with a psychologist is not a routine part of a headache evaluation, but might be done to identify stress factors triggering your headaches. Patients are typically asked to complete computerized questionnaires in order to provide more in-depth information.

Diagnostic tests

Additional diagnostic tests might be needed to rule out other medical conditions. These tests are listed below. Keep in mind that laboratory tests are not helpful in diagnosing migraine, cluster, or tension-type headaches.

  • Blood chemistry and urinalysis — These tests are used to determine other medical conditions — including diabetes, thyroid problems and infections — that can cause headaches.
  • Computed tomography (CT scan) — This is a test during which X-rays and computers are used to produce images of a cross-section of the body. A CT scan of the head might be recommended if you are getting daily or almost daily headaches to help rule out other causes of headaches.
  • Magnetic resonance imaging (MRI) — This test produces very clear pictures, or images, of the brain without the use of X-rays. MRI uses a large magnet, radio waves, and a computer to produce these images. An MRI provides information about the structure and biochemistry of the brain. An MRI might be recommended if you are getting daily or almost daily headaches. It might also be recommended if a CT scan does not show definitive results. In addition, an MRI scan is used to evaluate certain parts of the brain that are not as easily viewed with CT scans, such as the spine at the level of the neck and the back portion of the brain.
  • Sinus X-ray -— Although the CT scan and MRI provide more details, your doctor might use this test if your symptoms seem to indicate sinus problems.
  • An EEG, or electroencephalogram, is not a standard part of a headache evaluation.
  • Ophthalmology evaluation — An eye pressure test performed by an eye doctor (ophthalmologist) will rule out glaucoma or pressure on the optic nerve as causes of headaches.
  • Lumbar puncture or spinal tap — A lumbar puncture or spinal tap is the removal of spinal fluid from the spinal canal. This diagnostic procedure is only done to rule out conditions that might be affecting the brain and spinal cord. This test is used only if the symptoms warrant it, and it can cause a headache for a few hours afterward.

Conclusion

After evaluating the results of the headache history, physical examination, neurological and psychological examination, your doctor should be able to determine what type of headache you have, whether or not a serious problem is present, and whether additional tests are needed.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/1/2012...#9655


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