The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started. The key is to establish which type or classification of headache you have.
The first step is to go to your family physician. He or she will perform a complete physical examination and a headache evaluation. You will be asked to describe your headache history, symptoms, and characteristics as completely as possible.
After considering the results of the headache history and physical examination, as well as a neurological and psychological assessment, your doctor should be able to determine which type of headache you have, whether or not a serious problem is present, and whether additional tests are needed.
If your headache symptoms become worse or become more frequent despite treatment, ask your family physician for a referral to a specialist. If you need more information, contact one of the organizations in the resource list for a list of member physicians in your state.
This section contains more information on:
Your headache history
The most important part of the headache evaluation is the headache history, the part of the evaluation in which you describe your headache symptoms and characteristics as completely as possible. For headaches in children, the doctor will want to hear from both patient and parents.
- 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 the headaches occur
- What causes the headaches, if known (for example, do certain situations, foods, or medicines usually trigger the headaches?)
- 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
- If your school or work performance has been affected by the headaches
Your doctor will also ask additional questions about family background and if you have any history of drug abuse. How do you feel with the headache? More specifically, for example, you will be asked to describe:
- 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 warning signs occur with a headache (such as weakness, nausea, sensitivity to light or noise, appetite changes, changes in attitude or behavior)
A history of previous headache treatments is also an important part of the evaluation. Tell your doctor what medicines you have taken in the past and what medicines you are currently taking. You may want to write down a list, 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 exams
The doctor will perform a complete physical and neurological examination, looking 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 the time
- Muscle weakness, numbness, or tingling
- Speech difficulties
- Balance problems, falling
- Dizziness
- Vision changes (blurry vision, double vision, blind spots)
The focus is on ruling out diseases that might also cause headaches, such as epilepsy, multiple sclerosis, and other cerebrovascular diseases.
An interview with a psychologist may also be a part of the headache evaluation in both children and adults. Some 50 percent to 70 percent of chronic headache sufferers have some form of psychological condition. In the case of children, the psychologist usually meets with the child and the parents together and then with them separately for structured interviews. The parents are typically asked to complete computerized questionnairest to provide more in-depth information. Usually, no severe problems are discovered, but stress factors are often identified.
Other diagnostic tests
If the results of the physical exam show signs of a condition that may be causing the headaches, additional laboratory tests may be needed. These tests are listed below. Keep in mind that laboratory tests are not helpful in diagnosing migraine, cluster, or tension-type headaches.
Blood chemistry tests and urinalysis. These are used to test for 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. (Even in this age of magnetic resonance imaging, or MRI, the CT scan remains the procedure of choice to investigate brains for masses and bleeding.)
Magnetic resonance imaging (MRI). This test produces very clear 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. CT scan and MRI provide more details; however, your doctor might use this test if your symptoms seem to indicate sinus problems.
Ophthalmology evaluation. An eye pressure test performed by an 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 can cause a headache for a few hours afterward.
An electroencephalogram (EEG) is generally unnecessary but would be used if a person has lost consciousness during a headache.
More detail is provided about:
Computed tomography (CT scan)
Computed tomography, commonly known as a CT scan, uses X-rays and computers to produce images of a cross-section of the body. The patient must lie as still as possible as the table moves through the large, doughnut-shaped scanning device. Movement could blur the images produced by the scanner.
Careful preparation is very important for the test to be performed properly:
- If intravenous contrast material is required for your CT scan, you might be instructed to have a blood test before the CT scan appointment. The purpose of the blood test is to assure your doctor that the appropriate contrast agents will be used for an accurate diagnosis. Failure to obtain the blood test might delay your CT scan appointment.
- Drink only clear liquids after midnight the night before your scan. Clear liquids include clear broth, tea, strained fruit juices, strained vegetable soup, black coffee, plain gelatin, tomato juice, and ginger ale.
- Take nothing by mouth for four hours immediately before your scan.
- Continue taking your medicines as usual.
- You might be asked to change into a hospital gown, because snaps and zippers in street clothes can interfere with the scan. You also might be asked to remove your watch or any jewelry.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging is a test that produces very clear pictures of the human body without the use of X-rays. MRI uses a large magnet, radio waves, and a computer to produce these images. In most cases, the procedure takes 40 to 80 minutes, during which several dozen images may be obtained. Certain MRI exams require an intravenous injection of a contrast material called gadolinium. This helps identify certain anatomical structures on the scan images. Generally, you can resume your usual activities and normal diet immediately after the exam.
As the MRI scan begins, you will hear the equipment making a muffled thumping sound that will last for several minutes. Other than the sound, you should experience no unusual sensations during the scanning.
The MRI examination poses no risk to the average patient if appropriate safety guidelines are followed. Since the test involves a giant magnet, precautions must be taken with some metal objects.
Post-cardiac-surgery patients and patients with the following medical devices can be safely examined with MRI:
- Surgical clips or sutures
- Artificial joints
- Staples
- Cardiac valve replacements
- Disconnected medication pumps
- Vena cava filters (after six weeks for certain types)
- Brain shunt tubes for hydrocephalus
- Metal stents
Some conditions may make a MRI examination inadvisable. Tell your doctor if you have any of the following conditions:
- Heart pacemaker
- Cerebral aneurysm clip (metal clip on a blood vessel in the brain)
- Pregnancy
- Implanted insulin pump (for treatment of diabetes), narcotics pump (for pain medication), or implanted nerve stimulators ("TENS") for back pain
- Metal in the eye or eye socket
- Cochlear (ear) implant for hearing impairment
- Implanted spine stabilization rods
- Severe lung disease (such as tracheomalacia or bronchopulmonary dysplasia)
- Gastroesophageal reflux
- Weight of more than 300 pounds
- Inability to lie on back for 30 to 60 minutes
- Claustrophobia (fear of closed or narrow spaces). If this applies to you, you can receive sedation during the exam if prior arrangements have been made.
Electroencephalogram (EEG)
An electroencephalogram is a test during which the electrical signals of the brain are recorded. This electrical activity is detected by electrodes, or sensors, placed on the patient's scalp and transmitted to a polygraph that records the activity.
EEGs are not a standard part of a headache evaluation. However, an EEG might be performed to rule out other conditions, such as epilepsy. An EEG can indicate a malfunction of the brain, but it does not usually pinpoint the exact problem that might be causing a headache.
Before an EEG:
- Discuss any medicines you are taking with your doctor prior to your procedure.
- Wash your hair the night before the test. Do not use hair cream, oils, or spray on your hair.
During the EEG, you lie down on the examining table or bed while about 20 electrodes are attached to your scalp. You are asked to relax and lie first with your eyes open, then closed. You might be asked to breathe deeply and rapidly, or to stare at a flashing light. Both of these activities produce changes in the brain-wave patterns.
Electrical signals produced by the brain neurons are picked up by the electrodes and transmitted to a polygraph, where they produce separate graphs on moving paper using an ink writing pen or on a computer screen.
A neurologist examines the EEG recording for abnormalities in the brain-wave pattern, which might indicate a disease of the nervous system.
Last reviewed on 07/06/2006
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