In the first part of this series we discussed the different type of headaches and the possible causes. We also discussed the number of people in America who deal with headaches. I was actually shocked to find that more Americans present for care of headaches than any other condition. Now that we have looked at the kinds of headaches and the causes let's take a look at how headaches are diagnosed. In order to be able to get proper treatment of your headaches, a proper diagnosis is necessary. In order to get the proper diagnosis your doctor will need to ask you about your headaches. They will most likely ask questions about the characteristics of your headaches, and any symptoms that come along with your headaches. The following questions are examples of questions you can expect to be asked.
As you are asked these questions it is imperative that you answer the questions to the best of your ability.
- How old were you when you began having headaches??
- Do you experience one kind of headache (like migraines), or do you think you have more than one type of headache (migraines, sinus, hormonal headaches) ?!?
- Do you know what causes your headaches? (For example, do certain situations, locations, food or medications trigger your headaches)?
- Does anyone in your family have headache?
- What symptoms if any occur between headaches?
- Has your school or work performance been affected by your headaches?
During your visit to the doctor it is very important to tell them how you feel when you get a headache, any sensation before the headache and what happens (if anything) when you get the headache.
- Where is the pain located?
- What does the pain feel like (throbbing, aching, pounding)?
- How severe is the pain on a scale of 0 (no pain) to 10 (severe pain)?
- How long do the headaches last?
- Does the headache appear suddenly without warning, or gradually with accompanying symptoms, or a combination of both?
- Do your headaches occur at the same time of day?
- Do you have any kind of aura (change in vision, blind spots, seeing flashing lights) before the headache starts?
- What if any symptoms or warning signs occur with the headache (ex weakness, nausea, sensitivity to light or noise, appetite changes, change in attitude or behavior)?
- How frequently do your headaches occur?
It is important that you tell your doctor if you have been treated in the past for your headaches, and if so by what doctor. It is also important for the doctor to know what medications you have taken, or if you have taken any over-the-counter medications. If you take a lot of medications it is okay to bring all your medications in a bag to your appointment or ask your pharmacy for a print out. You should also share during your appointment if you have had any diagnostic studies (X-rays, MRI or CT Scan) because of your headaches, and where they were done so the doctor can get copies of the reports. This can save time and money by avoiding duplicate studies.
Physical and Neurological Exams to Diagnose Headaches
Once the provider has finished taking a full history of your headache events and symptoms they should continue on and do a full physical and neurological exam. During this exam they provided will look for any symptoms of illness that could be causing the headache. They will be looking for any of the following:
- Fever or any abnormalities in pulse, blood pressure or breathing
- Nausea &/or vomiting
- Any changes in personality, or any inappropriate behavior
- Loss of consciousness
- Excess fatigue, or wanting to sleep all the time
- Any muscle weakness, tingling or numbness
- Difficulty with speech
- Any problems with balance
- Any recent falls
- Vertigo or dizziness
- Any changes in vision
The neurological test that will be done are done to rule out any disease or issues with the brain, or any nerve issues that could be causing the headaches. There may also be done to look for any physical or structural abnormality of the brain that could be the cause of the headache. They are looking for things like tumors, infection of the brain, bleeding on the brain or any excess fluid on the brain.
While it is not necessarily a normal part of diagnosing headaches, you may be sent to a psychologist for evaluation. An appointment with a psychologist may be made to help identify any stress factors that could be triggering the headaches. If you are sent to a psychologist you will more than likely be asked to complete a computerized questionnaire. The questionnaire is used to provide much more in depth information to your doctor.
After you have seen the required doctors, they may decide to order further testing to help them determine what is causing your headaches. However, if you are experiencing migraines, cluster, tension or hormonal headaches the blood tests will not show anything definitive. They might order any of the following:
- Blood tests like a complete blood count (CBC) or a basic metabolic panel (cmp), and a urinalysis. With these tests they are looking for conditions like diabetes, problems with the thyroid or infections that could cause headaches.
- A CT Scan maybe ordered if you are having several times a week or daily headaches.
- A MRI may be ordered if you are having daily or almost daily headaches or as a follow up if the CT Scan does not give a definitive answer. An MRI may also be ordered to get a better picture of parts of the brain are not easily visualized with a CT Scan.
- An X-ray of the sinuses may be ordered if the provider thinks the sinuses are the cause of your headaches.
- An EEG is not a standard part of a evaluation of headaches. But it may be ordered if your provider thinks you could be having seizures.
- Eye Exam - Your provider may have you get an eye exam to check the pressure in your eye in order to rule out glaucoma or increased pressure on the optic nerve.
- A Spinal Tap May be done to look for conditions such as an infection of the brain or spinal cord, or an increased amount of cerebral spinal fluid which could be a cause of your headaches.
Once you have seen the doctors (your primary care, a neurologist and possibly a psychologist) and a compete headache history, physical, neurological and psychological exams have been completed your provider should be able to determine what kind of headache you are having.
Now that we know what kind of migraines there are as well as what causes them. And we have looked at what may be done to diagnose said headaches. Now in the final part of this study on migraines, which will post in a few days. We will spend some time looking into treatment options for of the kids of headaches we have discussed and diagnosed.
So stay tuned for part 3, later this week!!!