Diagnosing a headache is like playing Twenty
Questions. Experts agree that a detailed question-and-answer
session with a patient can often produce enough
information for a diagnosis. Many types of headaches
have clear-cut symptoms which fall into an easily
recognizable pattern.
Patients may be asked: How often do you have
headaches? Where is the pain? How long do the
headaches last? When did you first develop headaches?
The patient's sleep habits and family and work
situations may also be probed.
Most physicians will also obtain a full medical
history from the patient, inquiring about past head
trauma or surgery, eye strain, sinus problems,
dental problems, difficulties with opening and
closing of the jaw, and the use of medications. This
may be enough to suggest strongly that the patient
has migraine or cluster headaches. A complete and
careful physical and neurological examination will
exclude many possibilities and the suspicion of
aneurysm, meningitis, or certain brain tumors. A
blood test may be ordered to screen for thyroid
disease, anemia, or infections which might cause a
headache.
A test called an electroencephalogram (EEG) may
be given to measure brain activity. EEG's can
indicate a malfunction in the brain, but they cannot
usually pinpoint a problem that might be causing a
headache. A physician may suggest that a patient
with unusual headaches undergo a computed
tomographic (CT) scan and/or a magnetic resonance
imaging (MRI) scan. The scans enable the physician
to distinguish, for example, between a bleeding
blood vessel in the brain and a brain tumor, and are
important diagnostic tools in cases of headache
associated with brain lesions or other serious
disease. CT scans produce X-ray images of the brain
that show structures or variations in the density of
different types of tissue. MRI scans use magnetic
fields and radio waves to produce an image that
provides information about the structure and
biochemistry of the brain.
If an aneurysm-an abnormal ballooning of a blood
vessel-is suspected, a physician may order a CT scan
to examine for blood and then an angiogram. In this
test, a special fluid which can be seen on an X-ray
is injected into the patient and carried in the
bloodstream to the brain to reveal any abnormalities
in the blood vessels there.
A physician analyzes the results of all these
diagnostic tests along with a patient's medical
history and examination in order to arrive at a
diagnosis.
Headaches are diagnosed as
Vascular headaches - a group that includes the
well-known migraine - are so named because they are
thought to involve abnormal function of the brain's
blood vessels or vascular system. Muscle contraction
headaches appear to involve the tightening or
tensing of facial and neck muscles. Traction and
inflammatory headaches are symptoms of other
disorders, ranging from stroke to sinus infection.
Some people have more than one type of headache.
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