Diagnosing and treating headaches

How is a diagnosis made?

Accurately diagnosing a type of headache can be tricky, but is best done by a medical professional so as to ensure effective treatment. Once a cause has been established, diagnosis and treatment can be that much more accurate and effective.

In many cases, special diagnostic tests may not be necessary. When you find that your symptoms aren’t easily explainable or you feel that you are unable to clear or control them, it is advisable to see your doctor (general practitioner or GP) for a consultation.

He or she will talk you through your symptoms in more detail, asking questions relating to levels of severity (as well as what appears to worsen or clear your headaches), frequency and potential triggers and influences which may be causing your headaches, as well a detailed history (if relevant).

It’s important that you disclose as much information about your symptoms as you can as this can help your doctor to better determine a root cause.

Questions that may be asked include:

• How long ago / how old were you when your headaches first began?
• How frequently do you experience headaches?
• Do you experience a specific type of headache or multiple types?
• Do certain things, such as foods, medications or situations trigger your headaches?
• Are you experiencing stress at work, school or home?
• Where do you feel pain and how would you describe it?
• Would you describe the pain as mild or severe? (Usually rated on a scale of 1 to 10)
• How long do your headaches normally last?
• Does pain occur suddenly (without warning) or gradually?
• Do you experience any other symptoms?
• Do you experience any changes in your vision before or during your headache?
• Have you been treated for headaches in the past?
• Have you previously had tests done for headaches? If so, which ones have been done?
• Do you take any over-the-counter pain relievers, supplements or prescribed medications?

From there your doctor may request a physical exam to either check for or rule out potential causes, or assess any other accompanying symptoms such as abdominal or digestive discomforts.

Some signs your doctor may lookout for during your consultation include:

• Breathing, pulse or blood pressure abnormalities
• Infection or fever
• Mental confusion or inappropriate behaviours (personality changes)
• Fatigue
• Numbness or tingling sensations
• Difficulties with speech
• Problems with balance or dizziness
• Muscle weakness

A neurological exam may be recommended if your doctor feels the need to potentially rule out known conditions of the nerves or brain that may be the underlying cause of the headaches being experienced. Some conditions your doctor may have in mind to rule out or determine as a cause include a brain infection or abscess, tumours, brain haemorrhage, bacterial or viral meningitis, intracranial pressure (Pseudotumor cerebri), Lyme disease, hydrocephalus, encephalitis, blood vessel abnormalities or clots, sinus blockage or disease, an aneurysm or even signs of a potential head injury or trauma.

If stress or other stress factors (such as a mental health concern) is determined as a major factor during your consultation, you doctor may suggest a psychological evaluation.

Once all evaluations and exams are complete, your doctor should be able to determine the underlying cause and type of headache you are experiencing. If there is a sign of a more serious medical abnormality or condition, appropriate testing may be recommended.

In rare instances a diagnostic test may be required. This may involve an MRI or CT scan which assists your doctor with detailed images of your brain, and other areas of the body. If there are any abnormalities, such as swelling or bleeding, these tests will pick this up. Imaging tests are useful if you are experiencing headaches frequently (almost daily or daily).

Your doctor may even refer you to a specialist where he or she feels it may be more beneficial or necessary. In most instances, laboratory tests are not likely to be helpful in diagnosing tension and clusters headaches or migraine.

If tests are necessary, others which may be recommended include:

• Urinalysis and blood chemistry: Used to determine or rule out the possibility of thyroid problems, an infection or diabetes.
• Sinus X-ray: Used to pick up sinus problems, but these are more often than not seen in more detail in an MRI or CT scan.
• Spinal tap / lumbar puncture: If it is determined that there is any sign of fluid build-up in the brain or spinal cord due to an infection, a spinal tap is performed to remove this from the spinal canal (situated in the back).
• Electroencephalogram (EEG): If a person experiences seizures or loss of consciousness, this scan may be useful for determining a possible medical condition.
• Eye pressure test: You may be referred to an ophthalmologist for this test if there is possibly pressure on the optic nerve or signs of glaucoma.

Treatment for headaches

Unless your headaches are intense and occur fairly frequently or are diagnosed as part of an underlying illness, little treatment may be required. For the most part, treatment advice and recommendations will depend on the underlying cause and type of headache.

Many won’t require much medical intervention at all, but your doctor will assist with a treatment plan, including lifestyle adjustments (if necessary) to help alleviate your symptoms. Sometimes this plan will involve pain-relieving medications (over-the-counter or prescribed), stress management, biofeedback (techniques to assist you with gaining control over involuntary functions) and even counselling.

If medications are recommended, it is very important that you follow the dosage instructions. Some pain-relief medications are known to cause rebound headaches which can cause problems with withdrawal if discontinued inappropriately. If you take any over-the-counter medications, it is advisable to run these by your doctor beforehand to ensure that you don’t experience any adverse interactions with any other medications or supplements you are taking, or with stimulants such as caffeine for example.

You may be advised to keep a record of your headaches and note any changes or patterns (particularly the type of pain and timing or pattern or headache attacks), as well as what appears to be helping to alleviate pain or discomfort and what may be worsening your symptoms. You will also be advised to steer clear of any determined triggers such as certain environments, smells or foods. 

Your doctor will also likely encourage healthy habits, such as getting enough sleep, regular exercise, a nutritious diet, and request follow-up appointments to assess how you are managing or coping with your headaches.