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Diagnosing Headaches

What You Should Tell Your Doctor

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Updated July 22, 2009

Diagnosing headaches does not need to be a complicated matter. For your physician to properly diagnose your headache and prescribe an adequate treatment, it is important to relay symptoms in an orderly and logical format. You can follow this format to organize your thoughts and share them with your physician:

Character

What does your pain feel like? Medical professionals often describe pain as either “sharp and stabbing” or “dull and achy.” Burning pain can also occur in some cases. Occasionally, you may feel as though you are having a “pins and needles” type of sensation. In all cases, you should rate your pain for your physician. If 1 is very mild pain and 10 is the worse pain you’ve ever had in your life, give your pain a number on this scale. Be honest, but be warned: pain rated as an “11 out of 10” only serves to confuse the doctor. Also, if you call this headache “the worst I’ve ever had,” be sure it really is the worst headache you’ve ever experienced. Certain neurological problems can cause this type of severe headache.

Onset

When did it start? What were you doing at the time the headache began? Do you remember eating anything in particular before experiencing pain? Stress, lack of sleep, changes in the environment, and a variety of foods are some of the triggers for headaches.

Location

Where is your headache located? Some headaches occur on one side of the head (like most migraines) and some involve the entire head. Cluster headaches in particular often hurt behind one eye. Tension headaches feel like a band wrapping around the head. You may also feel like your headache begins at the base of the skull where the head and neck meet.

Duration

How long does your headache last? Headaches of all types can last anywhere from a few short minutes to a day or more. Some headaches come and go throughout the day. In any case, headaches that last longer than 24 hours should be reported to your physician to rule out a serious cause of headaches.

Exacerbation (“Makes it Worse”)/Relief

What seems to help the pain? What makes it worse? Migraines sometimes get better with rest, especially in a dark, quiet room. If you take medications for your headaches, are these helping? Describe any activities that seem to make your pain worse or better. Loud noises and bright light or excessive heat may make your headache worse. Be sure to tell your doctor these things.

Radiation

Does the pain travel anywhere else? Healthcare professionals like to know if your pain “travels.” Some headaches start in the neck and seem to reach all the way to the forehead. In some instances, you may feel like your headache starts on the right side but then begins to affect the left side of your head, as well. A cluster headache may start behind the eye, but then send sharp pain elsewhere in the head.

Associated Symptoms

What other symptoms do you get with your headache? Nausea is quite common with a lot of headaches. Some migraines cause a variety of symptoms including vision problems, diarrhea, and cold hands and feet. You should also tell your doctor if you develop an aura before experiencing a headache. An aura commonly affects your vision and may be flashing lights or a blind spot. Some people report emotional changes or food cravings prior to a headache. All of these symptoms can help your doctor properly assess your headaches.

Warning Signs

Some severe medical issues, such as meningitis and stroke, can cause headaches. If you experience any of the following symptoms, be sure to call your physician immediately:
  • An abrupt, severe headache
  • A headache with fever, stiff neck, seizures, difficulty speaking, rash, weakness, or double vision
  • Headaches following a head injury
  • Any time headaches begin for the first time after the age of 50

Sources:

Millea, Paul J., M.D. and Jonathan J. Brodie, M.D. “Tension-Type Headache.” Am Fam Physician. 2002;66:797-804,805.

NINDS Headache Information Page. National Institute of Neurological Disorders and Stroke. Retrieved September 2, 2008. http://www.ninds.nih.gov/disorders/headache/headache.htm

Parmet, Sharon, Cassio Lynm, and Richard M. Glass. ”Headache.” JAMA. 2006;295(19):2320. Retrieved September 2, 2008.

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