Headaches that are mild to moderate in intensity, not accompanied by other symptoms and responsive to treatment within a few hours do not usually require medical attention. However, headaches that are severe, recurrent or chronic should be brought to a physician’s attention. Headaches that interfere with sleep, occur with activity or present with additional symptoms also require examination by a physician.    

During an evaluation for headache, physicians take the patient’s medical history and perform a physical examination. Information provided during the pain assessment can help physicians determine whether a patient’s symptoms are the result of a primary headache or an underlying medical condition, such as sinus infection or an aneurysm.

While obtaining a patient’s medical history, physicians may ask the patient about their symptoms. Questions may focus on the characteristics of the pain, including its severity, location, frequency, duration and accompanying symptoms. The most common headaches, including tension headaches, migraines and cluster headaches, are usually accompanied by characteristic symptoms. By collecting detailed information regarding the headache, physicians are often able to determine the type of headache. These questions also enable physicians to focus the physical examination and avoid any unnecessary tests.

The physical exam may include measurements of blood pressure and pulse, as well as inspection of the head, eyes, ears, nose, throat, neck, spine and shoulders. A neurological exam is also commonly performed to evaluate the nervous system. This evaluation may involve a number of tests including getting up from a seated position without support, and walking on the tips of the toes and heels, as well as motor, sensory, reflex and coordination tests. These evaluations are used to exclude a number of possible causes.

Physicians may order a number of diagnostic tests when they are unable to link headache symptoms with a specific headache syndrome, if symptoms of serious underlying conditions are present, or abnormalities are uncovered during the neurological examination. These tests also help physicians exclude a number of possible causes.

Diagnostic tests may include:  

• MRI (magnetic resonance imaging). MRIs use a powerful magnetic field to create images of structures and organs within the body, allowing a computer to produce clear cross-sectional or three-dimensional images. This test may be ordered to examine the brain and rule out aneurysm and a number of other serious causes.

• CAT scan (computed axial tomography). This test allows for multiple x-rays to be taken from different angles around the patient. A computer analyzes the "slices" or cross-sectional images. After the first set of images is taken, the patient may receive an intravenous (I.V.) injection of a contrast agent (dye) to better outline the body parts. Then a second set of images is taken. This test may be ordered to examine the brain and rule out aneurysm and a number of other serious causes.
  
  
• Blood tests. These may be performed to screen for infections and other potential causes of headache.
  
  
• Electroencephalogram (EEG). Electrodes are placed on the head to measure the brain’s electrical activity. This test may be performed to exclude seizures.
  
  
• Sinus x-ray. This procedure produces images of the sinuses (air-filled cavities in the frontal bones on the skull that are lined with mucous membranes). This test may be performed to exclude sinus inflammation (sinusitis) as a cause of headache.
  
  
• Spinal tap. Also known as a lumbar puncture, this procedure uses a needle to remove a sample of cerebrospinal fluid (CSF) from between vertebrae in the lower spine. Although this test is rarely required, it may be ordered to rule out meningitis, hemorrhage or other possible underlying conditions that can cause severe headaches.
  
  
• Temporal artery biopsy. This procedure requires removal of tissue from the affected artery. The sample is then examined. This procedure may be used to rule out temporal arteritis.