John R. Graham
Headache Center

at Brigham and Women's Faulkner Hospital

Diagnosing a Headache

The full extent of the problem may not be understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history, physical examination and diagnostic tests.

Questions commonly asked during the exam may include, but are not limited to, the following:

  • When do headaches occur?
  • What is the location of the headache?
  • What do the headaches feel like?
  • How long do the headaches last?
  • Have there been changes in behavior or personality?
  • Do changes in position or sitting up cause the headache?
  • Do you have trouble sleeping?
  • Do you have a history of stress?
  • Is there a history of head injury?

If the history is consistent with migraine or tension-type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if it is not a primary type headache, then other tests may be needed to determine the cause.

Tests used to determine the cause of a headache may include:

  • Blood Tests - various blood chemistry and other laboratory tests may be run to check for underlying conditions.
  • Sinus X-rays - a diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.
  • Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
  • Computed Tomography Scan (CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.

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