Physical and neurological examinations for headaches
After completing the headache history, 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
- Nausea, vomiting
- Changes in personality, inappropriate behavior
- Mental confusion
- 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
- 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 disorder of the central nervous system might be suspected in the development of serious headaches. These include:
- 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)
- Infections, such as Lyme disease
An interview with a psychologist is not a routine part of a headache evaluation, but it might be done to identify stress factors that can cause your headaches. Patients are usually asked to complete computerized questionnaires in order to provide more in-depth information.
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): 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.
- 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 (spinal tap): The removal of spinal fluid from the spinal canal. This 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 call for it. It can cause a headache for a few hours afterward.
An EEG, or electroencephalogram, is not a standard part of a headache evaluation.