Medical Information from the Cleveland Clinic: Migraines and Headaches: Making the Diagnosis: Doctor's Exam

In order to receive proper treatment, a correct diagnosis of your headaches must be made. To properly diagnose the cause(s) of the headaches, your doctor will first take a headache history.

Headache History

The most important part of your doctor's evaluation of your headaches is what's called 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 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 medications 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

It is also important to tell your doctor how you feel when you get a 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 headache lasts
• If the headaches appear 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 a headache (such as weakness, nausea, sensitivity to light or noise, appetite changes, changes in attitude or behavior)
• How frequent you get headaches

You should also tell your doctor if you've been treated in the past for headaches and what medications (both prescribed and over-the-counter) you have taken in the past and what medications are currently being taken. Don't hesitate to list them, bring the bottles, or ask your pharmacist for a printout.

Studies performed by other doctors who may have evaluated your headaches in the past, including X-rays and other imaging tests are also very important -- you should bring these to your appointment as well. This may save time and repetition of 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 may 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 of the brain or nerves that may also cause headaches, such as epilepsy or multiple sclerosis. Some of the tests may also look for a physical or structural abnormality in the brain that may cause your headache, such as:

• Tumor
• Abscess (an infection of the brain)
• 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 such as meningitis or Lyme disease
• Encephalitis (inflammation and swelling of the brain)
• Blood clots
• Head trauma
• Sinus blockage or disease
• Blood vessel abnormalities
• Injuries
• Aneurysm (an outpouching of the wall of a blood vessel that can leak or rupture)