Diagnosing migraines and headaches
If migraines or headaches keep coming back, and affect your daily life, it may be time to seek medical advice.
Although over-the-counter painkillers can be effective for headache and migraine, if they are not working, seek medical advice. This is especially important if the headache pain is quality of life-limiting, or affects work or relationships.
It will help a doctor to diagnose headache or migraine types if you can keep a diary of the head pain, including how bad the pain was and any possible triggers.
The most important part of your doctor's evaluation of your headaches is what's called the headache history. It is important to describe your headache symptoms and characteristics as completely as possible. Your headaches can be better diagnosed if you tell your GP:
- How old you were when the headaches started?
- How long you have been experiencing them?
- If you experience a single type of headache or multiple types of headaches?
- How often the headaches occur?
- What causes the headaches, if known - for example, do certain situations, foods, or medications trigger the headaches?
- Who else in your family has headaches?
- What symptoms, if any, occur between headaches?
- If your school or work performance has been affected by the headaches?
It is also important to tell your GP 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 or with accompanying symptoms
- What time of day the headache usually occurs
- 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 behaviour)
- How frequently you get headaches
You should also tell your doctor if you've been treated in the past for headaches and what medications - prescribed and over-the-counter - you have taken in the past and what medications are currently being taken. Don't hesitate to list them or bring the packages when you visit your doctor.
Physical and neurological examinations to diagnose headaches
After completing the headache history portion of the evaluation, the doctor will perform a complete physical, including a neurological, examination. The doctor will look for signs and symptoms of a disease or illness that may be causing the headaches, such as:
- Fever or abnormalities in breathing, pulse, or blood pressure
- Nausea, vomiting
- Changes in personality, inappropriate behaviour
- 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 such as epilepsy and multiple sclerosis. Some of the tests may also look for a physical or structural abnormality in the brain that may cause your headache such as:
- Haemorrhage - bleeding within the brain
- Bacterial or viral meningitis - an infection or inflammation of the membrane that covers the brain and spinal cord
- Pseudotumor cerebri - idiopathic intracranial hypertension (IIH)
- Hydrocephalus - abnormal build-up of fluid in the brain
- Encephalitis - inflammation and swelling of the brain
- Blood clots
- Head trauma
- Sinus blockage or disease
- Blood vessel abnormalities
- Aneurysm - an outpouching of the wall of a blood vessel that can leak or rupture