Headache: Diagnosis

Since headaches arise from many causes, a physical exam assesses general health and a neurologic exam evaluates the possibility of neurologic disease that is causing the headache. If the headache is the primary illness, a doctor elicits a thorough history of the headache. Questions revolve around its frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This information aids in classifying the headache.

Warning signs that should point out the need for prompt medical intervention include:

• "Worst headache of my life." This may indicate subarachnoid hemorrhage from a ruptured aneurysm (swollen blood vessel) in the head or other neurological emergency.
• Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty, or other signs. This may indicate a stroke. Migraines may include neurological symptoms.
• Headache that becomes worse over a period of 6 months, especially if most prominent in the morning or if accompanied by neurological symptoms. This may indicate a brain tumor.
• Sudden onset of headache. If accompanied by fever and stiff neck, this can indicate meningitis.

Headache diagnosis may include neurological imaging tests such as computed tomography scan (CT scan) or magnetic resonance imaging (MRI).

— Julia Barrett