In order to receive proper treatment for headaches and migraines, a correct diagnosis must be made. That means your doctor will first ask you about the history of your headaches. 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 one (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 frequently 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. This may save time and repeated tests.
Physical and Neurological Exams to Diagnose Headaches
After completing the headache history portion of the evaluation, the doctor will perform a complete physical and neurological exam. 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
- 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 of the brain or nerves that may also cause headaches and migraines. The vast majority of headaches turn out to be benign in nature. Some of the tests look for a physical or structural abnormality in the brain that may cause your headache, such as:
- Brain 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
- Aneurysm (a "bubble" in the wall of a blood vessel that can leak or rupture)
Psychological Evaluation for Diagnosing Headaches
An interview with a psychologist is not a routine part of a headache evaluation, but it may be done to identify stress factors triggering your headaches. You may be asked to complete a computerized questionnaire to provide more in-depth information to the doctor.
After evaluating the results of the headache history and physical, neurological, and psychological exams, your doctor should be able to determine the type of headache you have, whether a serious problem is present, and whether additional tests are needed. Possible additional tests you may be given include diagnostic tests.
Tests for Diagnosing Headaches
Additional tests may be needed to look for other medical conditions that may be causing your headaches or migraines. These tests are listed below. Keep in mind that most of these laboratory tests are not helpful in diagnosing migraine, cluster, or tension headaches.
- Blood Chemistry and Urinalysis. These tests may determine many medical conditions, including diabetes, thyroid problems, and infections, which can cause headaches.
- CT Scan. This is a test in which X-rays and computers are used to produce an image of a cross-section of the body. A CT scan of the head may be recommended to rule out other conditions if you are getting daily or almost daily headaches.
- MRI. This test produces very clear pictures, or images, of the brain without the use of X-rays. MRI uses a large magnet, radio frequency (RF), and a computer to produce these images. A MRI may be recommended if you are getting daily or almost daily headaches. It may also be recommended if a CT scan does not show definitive results. In addition, a 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 may use this test if your symptoms seem to indicate sinus problems.
- EEG. Electroencephalogram is not a standard part of a headache evaluation, but may be performed if your doctor suspects you are having seizures.
- Eye Exam. An eye pressure test performed by an eye doctor (ophthalmologist) will rule out glaucoma or pressure on the optic nerve as a cause of headaches.
- Spinal Tap. A spinal tap is the removal of spinal fluid from the spinal canal (located in the back). This procedure is performed to look for conditions such as infections of the brain or spinal cord.