Sometimes, a headache is just that - a headache. Other times, a headache can be a symptom of another condition. In addition, there are different kinds of head pain, and treatments vary depending on the diagnosis. For these reasons, timely and accurate diagnosis is important if not critical.
In the United States Alone, 50 million people have frequent headaches that result in 157 million lost work days, $50 billion in healthcare expenses, and $10 million visits to doctors' offices. It is estimated that Americans spend $4 billion annually on over-the-counter medications for treatment of headache pain.
In spite of these staggering statistics, headaches and Migraine are still terribly misunderstood, even by some doctors. To improve this situation, proper diagnosis is the first step. Two of the most important factors in diagnosis are a thorough patient and family medical history and a patient head pain diary.
Since some types of head pain have a genetic component, it is helpful in diagnosis to know if there is a family history of headache or Migraine. If the patient does not know if there is such a family history, it's helpful to discover this before seeing the doctor. Making notes of family medical history and the patient's medical history will save time and avoid forgetting things during the appointment.
The diary contains critical information. It should be used to record the dates and times of head pain episodes, weather conditions, foods, activities, medications taken, the severity and duration of the head pain, and their impact on the patient's ability to function in their normal daily activities. Sometimes we can spot our own trends in our diaries. At times, doctors will spot trends we have missed.
In addition to the history and review of the diary, arriving at a diagnosis will include both common elements and some different elements, depending on the symptoms exhibited. The symptoms investigated include:
- the time of day the head pain occurs
- location of the pain
- type of pain (pulsing, throbbing, stabbing, etc.)
- associated symptoms - nausea, dizziness, photophobia, phonophobia, blurred vision
- severity of pain
- presence or absence of aura
- duration of the pain
- frequency of the head pain episodes
- whether the pain is made worse by movement
A thorough examination will begin with a general medical examination and include a neurological exam. At this time, it is important to rule out any organic cause of head pain such as lesions or vascular abnormalities. Depending on the outcome of these exams, imaging studies may be considered appropriate. These studies may include computed tomography (CT scan), magnetic resonance imaging (MRI), or Magnetic resonance angiography (MRA). The necessity of these studies has sometimes been debated. In 1994, the American Academy of Neurology published guidelines addressing neuroimaging for head pain patients:
"In adult patients with recurrent headaches that have been defined as Migraine-including those with visual aura, with no recent change in pattern, no history of seizures and no other focal neurological signs or symptoms, the routine use of neuroimaging is not warranted. In patients with atypical headache patterns and/or a history of seizures, or physical examination findings of focal neurological signs or symptoms, CT or MRI may be indicated."
The importance of proper diagnosis cannot be overemphasized. This forum post is an excellent demonstration of that point:
"... visit a specialist instead
of dismissing the problem... neurologist found a growth of pus to the
size of a golf ball on my brain that is pressing on the nerves causing
the horrible pains. I underwent
four operations to remove the abscess and am now recovering well. It was
a horrible experience so I hope others that are having throbbing
headaches take care of themselves."
About Headaches/Migraine Forum
An occasional headache is something most people experience. When head pain is frequent, is accompanied by unusual symptoms, or is severe, diagnosis is vital. Most people will begin with their family doctor. If he or she can diagnose and manage the head pain, your journey may end there. If not, referral to a neurologist and/or headache and Migraine specialist may be in order. If there are unusual visual symptoms present, a consultation with an ophthalmologist may be included as well.
Bottom Line: If you find yourself saying "It's just a headache," frequently, see your doctor. Ultimately, each of us is responsible for our own health.