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How are headaches diagnosed?

The diagnosis of headache disorder is made based on the history. Patients with headaches who are evaluated by health professionals have to provide a full history of their headaches and other medical conditions. Then they undergo a thorough medical examination and sometimes may need an MRI or a CT scan of their head in order to rule out other conditions.
Dr. Dawn Marcus
Neurologist

Headaches are diagnosed by matching your headache description to typical headache patterns. When your headache pattern is not typical, this can be more difficult. The doctor may need to review old tests you had done, order new tests, or confer with a colleague. Reviewing several weeks or months of headache diaries may also help determine your headache diagnosis. It is most time-efficient if you review your pattern before the visit and be ready to summarize it. For example, you may report that you tend to have on average 5-7 headaches per month with at least half of them consistently beginning 1-2 days before your menstrual period begins. Or, you might tell the doctor that your headaches seemed to get worse about 3 weeks ago after you started your new job. Observations such as these, based on your headache diary, can help direct treatment decisions.

The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

More About this Book

The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

Migraines are a common, controllable type of headache that affects one in every six women, more than 20 million in the United States alone. The Woman’s Migraine Toolkit helps readers take charge of...

Because headache is such a common problem, a thorough medical examination by your primary care physician is recommended for any chronic or recurring headache. An eye exam by an ophthalmologist (Eye M.D.) may be helpful in some cases.

You can help your physician determine the cause of your headache by describing your symptoms, noting when the headaches occur and providing a complete medical history, including any family history of recurring headaches.

For any chronic or recurring headache, a thorough medical examination by your primary care physician is recommended. Learn more from our experts about headaches.

The recognized authority for headache diagnosis is the International Headache Society (IHS) classification, which focuses on the clinical features of headaches. A clinical interview by a doctor provides the information for classifying headache symptoms according to IHS criteria. Physical or neurological examination is rarely necessary or beneficial, and brain scans are rarely taken.

Questions included in a well-constructed clinical interview focus on the four major characteristics of headaches:
  • quality (tightening or pulsating)
  • intensity (mild, moderate, severe, or very severe)
  • location (one or both sides of head)
  • response to routine physical activities (worsened or unchanged)
The doctor may gather additional information from the person suffering with a headache concerning the following:
  • headache accompaniments, which include nausea and/or vomiting; unusual sensitivity to light, sound, or odors; and aura before the onset of headache pain
  • use of nonprescription or prescription medications
  • treatment of headache pain with self-care approaches and the subjective rating of the pain relief achieved with these approaches

Dr. Dawn Marcus
Neurologist

Headaches are diagnosed by matching your headache description to typical headache patterns. When your headache pattern is not typical, this can be more difficult. The doctor may need to review old tests you had done, order new tests, or confer with a colleague. Reviewing several weeks or months of headache diaries may also help determine your headache diagnosis. It is most time-efficient if you review your pattern before the visit and be ready to summarize it. For example, you may report that you tend to have on average 5-7 headaches per month with at least half of them consistently beginning 1-2 days before your menstrual period begins. Or, you might tell the doctor that your headaches seemed to get worse about 3 weeks ago after you started your new job. Observations such as these, based on your headache diary, can help direct treatment decisions.

The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

More About this Book

The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

Migraines are a common, controllable type of headache that affects one in every six women, more than 20 million in the United States alone. The Woman’s Migraine Toolkit helps readers take charge of...
Considering how common headaches are and the long list of potential causes, remarkably few people need special testing. People with a long history of headaches that haven't changed much in intensity or frequency are less likely to need additional tests than people just starting to experience headaches or whose headaches have gotten worse. Pain that occurs consistently in the same location or on one side of the head—which could result from an underlying medical condition, such as a tumor or a blood vessel abnormality—may also warrant a more detailed evaluation.

On the other hand, a headache that regularly shifts from one side to the other may not, since this suggests a less ominous cause such as stress or fatigue. No tests are needed for obvious tension or migraine headaches. However, doctors sometimes recommend a computed tomography (CT) scan to determine the cause of sinus headaches. If your doctor decides on further testing, he or she may order a scan using CT or magnetic resonance imaging (MRI). Each of these procedures can show the body's internal structures.

Your doctor will likely diagnose your headaches based on a conversation with you. Your doctor will ask about your symptoms. If something such as a cold is causing your headache, your doctor will treat that condition. If your symptoms are not being caused by an obvious secondary source, your doctor will ask you questions about your lifestyle and the frequency with which the headaches occur.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.