Diagnosing Headaches

Given that nearly every adult has suffered from a headache, diagnosing headaches should be the simplest thing in the world. When you have one, you know it. But despite the obvious and easily perceived pain, diagnosis can be a little trickier than one might suppose.

Physicians have no general and definitive set of tests for diagnosing headaches. If you feel it, you feel it. But no one else can literally and directly feel your pain, so doctors have to rely on what you report. And, when it comes to reporting symptoms, descriptions can vary wildly.

Some people simply aren't as articulate as others in describing what they feel. The vocabulary for describing it is lacking to an extent as well. Calling a feeling a 'stabbing pain' is (literally speaking) just a metaphor. In many cases, the pain is diffuse, making it difficult to report even the location accurately.

Another difficulty in diagnosis lies in the fact that headaches are not all of one type.

Simple tension headaches - produced by inflamed neck or facial muscles, constricted head blood vessels and other causes - don't generally get diagnosed professionally at all. They're treated with analgesics or just endured until they fade. Migraines, on the other hand, are more intense and periodic. Even here almost half of migraine sufferers never see a physician for their condition.

Physicians can use some objective factors in diagnosing the type of headache, in order to recommend a reasonable treatment.

Even though the pain is subjective, the type of pain is indicative of the type of headache. Migraines, for example, often produce intense throbbing or pulsating sensations. Ordinary tension headaches are typically more regular and diffuse.

Migraine headaches are often accompanied by nausea and vomiting, sensitivity to light and sound, cold extremities and other signs that those afflicted recognize. Since they tend to be roughly the same from one person to another, that forms an objective group of symptoms that professionals can rely on to form a proper diagnosis.

Cluster headaches are intense pain behind the eye, or temple, that occur for short periods (30 min to 1.5 hours, typically), then re-occur the next day around the same time. This can go on for weeks. Since it's fairly regular, here again physicians have something to go on.

In cases where the headache is the effect of some serious underlying neurologic or other condition, such as a brain tumor, physicians can look for those factors when headaches are reported.

CT or MRI scans can be used to look for well-documented brain activity patterns that can correlate the headache to the underlying physical problem. Headaches that progressively worsen provide doctors an additional clue. Patterns which shift rapidly are another. In some cases an aneurysm (weakening of a blood vessel) that is the root cause can be detected this way.

In those cases where the headache is the result of incorrect medication use - MOH (medication overuse headache) - physicians have the history of the medication used to assist their diagnoses. Medical history of another sort is helpful, too. Migraines run in families, while cluster headaches do not.

The diagnosis of headaches is as complex as the types and range of symptoms. But the key in all cases is to gather as much objective information as possible, both from the patient and clinical tests.

Seeking Medical Advice for Headaches

Diagnosis of nearly any medical condition is harder than it seems. For example, many people who believe they have sinusitis (an inflammation of the sinus cavities that produces headache pain), often actually have a mild migraine. According to one reliable study, 97% of the participants misdiagnosed their condition, in fact having migraines.

But you can improve the odds of getting a correct diagnosis from your physician by giving him or her all the assistance you can.

Headache Diary

First and foremost, for those who have frequent headaches, keeping a diary is a must. The diary should note when it began and ended, as accurately as possible. Note the location and type of pain as well as you can. Though pain is subjective, it's helpful to make notes about the severity, too.

Knowing the degree, type and frequency of a headache is the first step to differentiating between, say, a migraine and a cluster headache, or an ordinary tension headache. Migraines produce a pulsating pain that strikes at odd moments, while cluster headaches tend to occur around the same time every day for weeks.

Make careful notes about diet, exercise and life-factors, too.

Changes in diet can lead to certain headaches. Chocolate, red wine, cheese and other foods and drinks are often triggers for those who are a sensitive. Excess exercise can often produce headaches, though how much is excessive will, of course, vary from person to person. Life-factors, such as moving to a new town, work or relationship stress and others can produce headaches.

When those factors lead to an ordinary tension headache that responds to aspirin or acetaminophen, then doesn't reoccur, there's little to do. But when the condition becomes more intense or long-lived, that diary is essential to providing physicians with needed clues for proper diagnosis.

Advanced Tools

There are literally hundreds of underlying medical conditions that can produce so-called 'secondary headaches'. That is a headache in which the head pain and its cause is not the primary factor. In 'primary headaches' the head pain is itself the medical condition.

No one, not even physicians, can always detect correctly at first which of these possible conditions is responsible. But they have the tools that can narrow them down. CT scans and MRI are two of the most common.

CT (Computer Tomography) scans use a series of directed x-rays that are combined by the computer to provide a 3-D 'picture' of the brain. MRI (Magnetic Resonance Imaging) does not use x-rays, but the electromagnetic activity of the brain itself, to map structures and conditions within the skull.

Both those have become outstanding diagnostic tools to determine the type of headache and any possible underlying neurological condition that might be producing it. In rare (but often obvious, once the tests are complete), cases a brain tumor or cancer is the underlying cause of headache.

Between these two sets of information - that gathered by the patient, and those used by the physician - diagnosis isn't automatic or flawless. But the odds of correctly assessing any regular, intense or long-lived headache pain are greatly improved.