After finding out your headache history (that is, after asking you a series of questions about your headaches), your health care provider will perform a physical examination. Often this exam will focus on your blood pressure and areas in your head, neck and face that could be a source of pain. For example, your health care provider will feel the muscles of your temples and neck, check for tenderness over your sinuses, look at your teeth and examine your eyes. Also, your doctor will look into your eye with an ophthalmoscope to see if there are any signs of increased pressure around the brain.
Your health care provider also will perform an examination of your nervous system. This often includes testing your reflexes, strength, sensation, balance and coordination. He or she also may check your thinking ability and your emotional state.
In most people — especially those with primary headaches — the physical examination will be normal.
Occasionally your health care provider may recommend additional tests to determine the cause of your headaches. For example, he or she may order special X-rays if a chronic sinus infection is thought to trigger your pain. Sometimes special blood tests are warranted as well.
Many people who develop new or severe headaches worry that there is something seriously wrong with their brain, such as a tumor or aneurysm. They may have heard about a friend or family member who had headaches and then was diagnosed with a life-threatening condition. However, the overwhelmingly majority of people experiencing new or severe headaches do not have a brain tumor, infection, aneurysm or any other type of life-threatening medical condition.
If your health care provider suspects a serious underlying condition or is otherwise unable to make a clear diagnosis, he or she may order special imaging tests of the brain. "Should I have computed tomography (CT) or magnetic resonance imaging (MRI) scan?" may be one of the most pressing questions you have. But in more than 98 percent of cases, the findings on a brain CT or MRI are entirely normal. Because these scans are quite expensive, MRI scans often cost $1,000 or more, your health-care provider may use specific criteria to decide whether or not you should have one of these special tests.
After taking a history, performing an examination and ordering any special tests, your health care provider will try to decide what type of headaches you are suffering from.
Making a specific diagnosis accomplishes several things. It tells you what you do have and also what you don't have. It helps you and your health care provider decide on specific treatment.
For example, certain drugs work exceptionally well for migraines but won't help a tension-type headache or headache caused by neck arthritis. A specific diagnosis also tells something about the possible future course that your headaches may take. For example, people with cluster headaches can expect their headaches to go away within several weeks, but they can expect the headaches to return at some point in the future.
Occasionally a health care provider may not be able to reach a firm diagnosis, even after extensive testing. Fortunately, it is rare that this lack of certainty stands in the way of finding effective treatment. Your health care provider may refer you to a specialist if he or she has lingering concerns about the correct diagnosis.