How are headaches evaluated and diagnosed?
If you have headaches often or if they are very severe, reach out to your healthcare provider. You can usually start with your family physician, where the diagnosis process will begin. It’s important to diagnose headaches correctly so that specific therapy can be started to help you feel better. Your healthcare provider will complete a physical examination, discuss your medical history and talk to you about your headache symptoms. This conversation is part of a headache evaluation. During the headache evaluation, your provider will ask you about your headache history, including:
- A description of your headaches.
- What the headaches feel like.
- How often the headaches happen.
- How long the headaches last each time.
- How much pain the headaches cause you.
- What foods, drinks or events trigger your headaches.
- How much caffeine you drink each day.
- What your stress level are.
- What your sleep habits are like.
- If you have any work issues.
Your headache can be more accurately diagnosed by knowing:
- When the headache started.
- How long you have had the headache.
- Whether there is a single type of headache or multiple types of headaches.
- How often the headache occurs.
- What causes the headache, if known (for example, do certain situations, foods, or medications usually trigger the headache?).
- If physical activity aggravates the headache pain.
- What events are associated with the headache.
- Who else in your family has headaches.
- What symptoms, if any, occur between headaches.
Your doctor will also ask additional questions about performance at work, family background, and if there is any history of drug abuse.
Clinical description of headaches
Describe how you feel when you have the headache and what happens when you get the 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).
- If the headache appears suddenly without warning or with accompanying symptoms.
- What time of day the headache usually occurs.
- If there is an aura (changes in vision, blind spots, or bright lights) before the headache.
- What other symptoms or warning signs occur with the headache (weakness, nausea, sensitivity to light or noise, decreased appetite, changes in attitude or behavior).
- How long the headache lasts.
History of headache treatments
You should provide your physician with a history of prior headache treatments. Tell your doctor what medications you have taken in the past and what medications are you currently taking. Don't hesitate to list them, bring in the medication bottles or ask your pharmacist for a printout.If any studies or tests were previously performed, bring them with you. This may save time and repetition of tests.
Physical and neurological examinations for headaches
After completing the medical history part of the evaluation, your physician will perform physical and neurological examinations. The physician will look for signs and symptoms of an illness that may be causing the headache. These signs and symptoms can include:
- High blood pressure
- Muscle weakness, numbness, or tingling
- Excessive fatigue, wanting to sleep all of the time
- Loss of consciousness
- Balance problems, falling
- Vision problems (blurry vision, double vision, blind spots)
- Mental confusion or changes in personality, inappropriate behavior, speech difficulties
- Nausea, vomiting
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
After evaluating the results of your headache history, physical examination and neurological examination, your physician 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.
If possible, try to write down how you feel when you are experiencing a headache. Keeping a journal of your headaches and how they make you feel can be helpful when you are talking to your healthcare provider.
The information you give your healthcare provider about your headaches is the most important part of the diagnosis process. By giving your provider as much information as possible about your headaches, you’re more likely to get an accurate diagnosis and a treatment plan that will help you feel better.
Although scans and other imagining tests can be important when ruling out other diseases, they do not help in diagnosing migraines, cluster or tension-type headaches. However, if your healthcare provider thinks that your headaches are being caused by another medical condition, there are several imaging tests that may be done. A CT scan or MRI can be used if your provider thinks your headaches are connected to an issue with your central nervous system. Both of these tests produce cross-sectional images of the brain that can show any abnormal areas or problems. X-rays of your skull are generally not done. An EEG (electroencephalogram) may not be needed unless you’ve ever passed out during a headache.