Brain & Nervous System Headaches Diagnosis Headaches Guide Headaches Guide Symptoms Causes Diagnosis Treatment Coping How Headaches Are Diagnosed By Colleen Doherty, MD Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis. Learn about our editorial process Updated on April 27, 2022 Medically reviewed by Diana Apetauerova, MD Medically reviewed by Diana Apetauerova, MD LinkedIn Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts University. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Assessment Labs and Tests Imaging Determining Type Differential Diagnoses Next in Headaches Guide How Headaches Are Treated Diagnosis of a headache takes several things into account, including when episodes occur, what symptoms you experience, how they respond to treatments you've tried, your overall health profile, and more. By performing a detailed history and physical exam, and perhaps some testing, your healthcare provider will work to identify what type of headache you are experiencing or, if a headache disorder is not at the root of your pain, what other condition may be causing your symptoms. PeopleImages/E+/Getty Images Assessment Your healthcare provider will do a physical examination, which will give details about your blood pressure and cardiorespiratory functions. A neurological examination will evaluate your sensory responses, muscle and nerve function, and coordination and balance. Your healthcare provider will also make note of your personal and family medical history, any medications you are taking, and your lifestyle habits (e.g., caffeine intake, alcohol use, smoking). When evaluating you, your healthcare provider will first likely ask you several specific questions about your headache. These questions include: Location: Where is the pain located?Onset: Was the onset of your head pain rapid or gradual?Duration: How long has the pain been going on for? Is the pain constant or intermittent?Character: How would you describe your headache? (e.g., throbbing, aching, burning, or sharp)Severity: How significant is your pain on a scale of 1 to 10? Would you describe your headache as mild, moderate, or severe? Is this the worst headache of your life?Radiation: Does the pain radiate? If so, where?Exacerbating or alleviating factors: What makes the pain better or worse?Associations: Are there other symptoms associated with your headache? (e.g., nausea, vomiting, visual changes) Your healthcare provider may also use responses to the POUND mnemonic or the ID Migraine Questionnaire. Based on this information, your healthcare provider can decide whether or not your headache is a type of primary headache disorder or possibly due to something else. Labs and Tests There aren't lab tests that are specific for diagnosing primary headache disorders. You may have blood and urine tests to assess your general health and rule out the causes of secondary headaches, such as infection, dehydration, diabetes, and thyroid disorders. If an infection of the brain or spinal cord is suspected, your healthcare provider may do a spinal tap to assess the pressure of the fluid and analyze it for infectious agents. An electroencephalogram (EEG) may be performed if your headaches have accompanied any symptoms of seizures. Imaging Although they are not a routine part of a headache workup, your healthcare provider may order imaging tests if you have symptoms that point to a structural cause for your headaches. This may be recommended if you have headaches almost every day or if your healthcare provider thinks you may have sinus problems. Imaging procedures might include X-rays, computed tomography (CT) scan, or magnetic resonance imaging (MRI). Determining Headache Type Certain distinct characteristics of the three main headache types—tension-type, cluster, and migraine—help healthcare providers determine exactly what type of primary headache concern is at play, one is suspected. Characteristics Assessed During Diagnosis Tension Headaches Cluster Headaches Migraines Character Pressing, tightening, "rubber-band-like sensation" around the head Sharp, burning, piercing Throbbing, pulsating Severity Mild to moderate Severe to very severe Moderate or severe Exacerbating Smoking, especially in chronic cases Alcohol, histamine, and nitroglycerin, especially in chronic cases Bright lights, loud noises Alleviating Factors Over-the-counter pain relievers Triptans, oxygen therapy NSAIDs, triptans, sleep Pain Radiation From the back of the head into the neck muscles, though this is variable Variable Variable Onset Gradual (usually more so than a migraine) Rapid Gradual Duration 30 minutes to 7 days 15 to 80 minutes, if left untreated 4 to 72 hours Associations Photophobia or phonophobia Autonomic symptoms (e.g., same-sided eye tearing, nasal congestion, and/or discharge) Nausea, vomiting, phonophobia, photophobia, migraine aura Location Bilateral Strictly unilateral and either orbital or supraorbital (around the eye) or temporal Unilateral (typically) Tension-Type Headaches Tension-type headaches are usually bilateral, non-pulsating, are not exacerbated by routine physical activity and are not associated with nausea or auras. They can be associated with photophobia or phonophobia (sensitivity to light and sound, respectively). (Note that, according to the criteria created by International Classification of Headache Disorders, tension-type headaches can only be associated with either photophobia or phonophobia—not both.) Frequent tension-type headaches often coexist with migraine without aura, so maintaining a headache diary is critical, as a treatment for these conditions is distinct. Overview of Tension Headaches Cluster Headaches A cluster headache—also known as a “suicide headache” due to its severe, debilitating intensity—plagues men more than women. These headaches occur in clusters or periods of time that typically last from one week to one year followed by pain-free periods of at least one month, though there are exceptions. During an episodic cluster headache, the sufferer can experience multiple attacks, typically for up to eight days. Some individuals suffer from chronic cluster headaches in which a headache period will either last for more than one year straight or pain-free periods will occur but will be less than one month. In addition to the autonomic symptoms mentioned above, cluster headaches may also cause eyelid swelling, forehead, and facial sweating, miosis and/or ptosis, and agitation and/or restlessness. An Overview of Cluster Headaches Migraines Migraines are more than just headaches. A migraine is a common, neurologic condition that may or may not be associated with a migraine aura, a disturbance that classically causes visual symptoms, but also may include other neurologic symptoms, like sensory or speech alterations. An Overview of Migraines Differential Diagnoses Your healthcare provider will consider whether there might be an infectious cause for a headache. You might have a headache with many types of viral, bacterial, fungal, or parasitic infections. Of special concern are infections of the brain or spinal cord. A stroke, hemorrhage, or blood clot in the brain is a serious condition that might present with a headache, and your healthcare provider will want to ensure one isn't missed, if present. High blood pressure or recent trauma might lead to these problems. There may be a structural cause for the headache, such as a tumor, abscess, or buildup of fluid in the brain. A headache can also be the result of taking pain medication too often. A Word From Verywell When assessing your headache disorder, your healthcare provider will likely ask you a lot about your symptoms to better understand them. It may be a good idea to write down answers to the above questions prior to your visit, so you are best prepared. Try to be thorough and proactive when evaluating your own headaches, so that together you and your healthcare provider can create an effective treatment plan. Treatment Options for Headaches 7 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. May A. Hints on Diagnosing and Treating Headache. Dtsch Arztebl Int. 2018;115(17):299-308. doi:10.3238/arztebl.2018.0299 Pluta RM, Lynm C, Golub RM. JAMA patient page. Tension-type headache. JAMA. 2011;306(4):450. doi:10.1001/jama.2011.886 Santos T, Morais H. Chronic Cluster Headache with an Atypical Presentation and Treatment Response. Case Rep Neurol Med. 2016;2016:5230127. doi:10.1155/2016/5230127 Bartleson JD, Cutrer FM. Migraine update. Diagnosis and treatment. Minn Med. 2010;93(5):36-41. Prakash S, Patel N, Golwala P, Patell R. Post-infectious headache: a reactive headache?. J Headache Pain. 2011;12(4):467-73. doi:10.1007/s10194-011-0346-0 Ahmadi aghangar A, Bazoyar B, Mortazavi R, Jalali M. Prevalence of headache at the initial stage of stroke and its relation with site of vascular involvement: A clinical study. Caspian J Intern Med. 2015;6(3):156-60. Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf. 2014;5(2):87-99. doi:10.1177/2042098614522683 Additional Reading Hainer BL, Matheson EM. Approach to an Acute Headache in Adults. Am Fam Physician. 2013 May 15;87(10):682-7. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 3rd Edition. Cephalalgia 2013 Jul; 33(9): 629:808. doi: 10.1177/0333102413485658 Weaver-Agostoni J. Cluster headache. Am Fam Physician. 2013 Jul 15;88(2):122-8. By Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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