In order to get the right treatment for headaches and migraines, you need a correct diagnosis first. Your doctor will do that by asking about your history of headaches and by getting a full picture of your health.
Your headaches can be better diagnosed if you tell your doctor:
- How old you were when the headaches started
- How long you've had them
- If you have a single type of headache or multiple types
- How often you get them
- What causes your headaches (for example, certain situations, foods, or medications)
- Who else in your family has headaches
- What symptoms, if any, occur between headaches
- If your school or work performance has been affected
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
- What time of day the headache usually happens
- 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 often you get headaches
You should also tell your doctor if you've been treated in the past for headaches, what medications (both prescribed and over-the-counter) you have taken in the past, and what medications you currently take. Also bring any tests you’ve had for headaches, such as X-rays and other imaging scans. That may help you avoid unnecessary tests.
Track Your Symptoms
When you get a migraine, it can be hard to remember what happened before it hit. A symptom tracker can help you understand the patterns and what may be the cause. No matter if you choose to track your migraines in a smartphone app, a spreadsheet, or a diary, the key is simply to do it.
This type of information is important to include:
- When did the pain start, get worse, and drop off?
- Where is the pain the strongest?
- Describe the pain. Is it sharp, pounding or a dull ache?
- How long did it last?
- Did you take medication? When?
- Did you try other treatments? Warm towel?
- Did the medication or treatment work?
Include lifestyle details, too:
- How much sleep do you get?
- Do you exercise? How much?
- What do you eat?
- What is the weather like?
- Are you under stress?
- If you get periods, write down their details.
Physical and Neurological Exams to Diagnose Headaches
After collecting your headache history, 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 buildup 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 bulge in the wall of a blood vessel that can leak or burst)
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 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 tell the type of headache you have, whether it's serious, and whether more tests are needed.
Tests for Diagnosing Headaches
You might need to take more tests to look for other medical conditions that may be causing your headaches or migraines. 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. It uses a large magnet, radio waves, and a computer to produce these images. An 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, 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 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 will rule out glaucoma or pressure on the optic nerve as a cause of headaches.
- Spinal tap. This is the removal of fluid from your spine. It looks for conditions such as infections of the brain or spinal cord.
Questions to Ask Your Doctor
Make the most of your doctor appointment by preparing a list of questions that you won’t want to forget. Here are some examples:
What could be causing my migraines?
- Do I need tests?
- Will my migraines get better?
- What is the best treatment for me?
- Are there non-drug options that will help?
- What if my medication does not work?
- Will changes to my lifestyle or diet make a difference?
- Could there be other reasons I have migraine symptoms?