Diagnosis of Headache

Diagnosing Your Headache

The circumstances under which a person experiences a headache can be key to diagnosing its cause. Keeping a headache journal can help a physician better diagnose your type of headache and determine the best treatment. After each headache, note the time of day when it occurred; its intensity and duration; any increased sensitivity to light, sound, or odors; nausea or vomiting; activity immediately prior to the headache; use of prescription and nonprescription over-the-counter medicines; amount of sleep the previous night; any stressful or emotional conditions; any influence from weather or daily activity; foods and fluids consumed in the past 24 hours; and any known health conditions at that time. Women should record the days of their menstrual cycles. Include notes about other family members who have a history of headache or other disorder. A pattern may emerge that can be helpful to reducing or preventing headaches.

Once the doctor has reviewed the individual’s medical and headache history and conducted a physical and neurological exam, lab screening and diagnostic tests can help rule out or identify conditions that might be the cause of the headaches.

Blood tests and urinalysis can diagnose brain or spinal cord infections, blood vessel damage, and toxins that affect the nervous system.

Testing a sample of the fluid that surrounds the brain and spinal cord (obtained through a procedure called a lumbar puncture) can detect infections, bleeding in the brain (called a brain hemorrhage), and measure any buildup of pressure within the skull.

Diagnostic imaging, such as with computed tomography (CT) and magnetic resonance imaging (MRI), can detect irregularities in blood vessels and bones, certain brain tumors and cysts, brain damage from head injury, brain hemorrhage, inflammation, infection, and other disorders.

Neuroimaging also gives research doctors a way to see what's happening in the brain during headache attacks.

An electroencephalogram (EEG) measures brain wave activity and can help diagnose brain tumors, seizures, head injury, and inflammation that may lead to headaches.

Source: NINDS (NIH)1

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It may be difficult to identify the type of headache because children often have problems describing where it hurts, how often the headaches occur, and how long they last. Asking a child with a headache to draw a picture of where the pain is and how it feels can make it easier for the doctor to determine the proper treatment.

Source: NINDS (NIH)2

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What tests are used to find out if I have migraine?

If you think you get migraine headaches, talk with your doctor. Before your appointment, write down:

  1. How often you have headaches
  2. Where the pain is
  3. How long the headaches last
  4. When the headaches happen, such as during your period
  5. Other symptoms, such as nausea or blind spots
  6. Any family history of migraine
  7. All the medicines that you are taking for all your medical problems, even the over-the-counter medicines (better still, bring the medicines in their containers to the doctor)
  8. All the medicines you have taken in the past that you can recall and, if possible, the doses you took and any side effects you had

Your doctor may also do an exam and ask more questions about your health history. This could include past head injury and sinus or dental problems. Your doctor may be able to diagnose migraine just from the information you provide.

You may get a blood test or other tests, such as CT scan or MRI, if your doctor thinks that something else is causing your headaches. Work with your doctor to decide on the best tests for you.

Source: OWH (DHHS)3

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When to seek medical help

There's usually no need to see your GP if you only get occasional headaches. However, see your GP if you get headaches several times a week or your headaches are severe.

Your GP will ask questions about your headaches, family history, diet and lifestyle to help diagnose the type of headache you have.

You should seek immediate medical advice for headaches that:

These symptoms suggest there could be a more serious problem, which may require further investigation and emergency treatment.

Source: NHS Choices UK4

Differential Diagnosis for Headache

Although fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body's hormone levels, and even changes in the weather.

There also are differences in how types of headaches respond to treatment with medicines. Although some over-the-counter drugs used to treat tension-type headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension-type headaches for most people.

You can't tell the difference between a migraine and a tension-type headache by how often they occur. Both can occur at irregular intervals. Also, in rare cases, both can occur daily or almost daily.

Source: OWH (DHHS)5

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How can I tell if I have a migraine or a sinus headache?

Many people confuse a sinus headache with a migraine because pain and pressure in the sinuses, nasal congestion, and watery eyes often occur with migraine. To find out if your headache is sinus or migraine, ask yourself these questions:

In addition to my sinus symptoms, do I have:

If you answer “yes” to two or three of these questions, then most likely you have migraine with sinus symptoms.

A true sinus headache is rare and usually occurs due to sinus infection. In a sinus infection, you would also likely have a fever and thick nasal secretions that are yellow, green, or blood-tinged. A sinus headache should go away with treatment of the sinus infection.

Source: OWH (DHHS)6

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  1. Source: NINDS (NIH): ninds.nih.gov/ disorders/ headache/ detail_headache.htm
  2. ibid.
  3. Source: OWH (DHHS): womenshealth.gov/ a-z-topics/ migraine
  4. Source: NHS Choices UK: nhs.uk/ conditions/ tension-headaches/ 
  5. Source: OWH (DHHS): womenshealth.gov/ a-z-topics/ migraine
  6. ibid.

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Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.