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Headache
A guide to headache causes and treatments
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How is the diagnosis made?
Most kinds of headache can be diagnosed from the type of pain, supplemented by a physical examination by the doctor. It is unusual to need to do many tests to confirm the diagnosis, and most tests that are done are designed to rule out possible alternative causes of headache in order to support a diagnosis of tension-type headache, migraine or cluster headache. Tests are often not necessary if the headache follows a standard pattern, particularly if the person feels better after reassurance and simple treatment, but anyone who does not improve or has unusual features to his or her attacks may have to undergo a few tests.
Simple blood tests are not usually of much use, but there is one test called the ESR (Erythrocyte Sedimentation Rate) which is helpful in diagnosing temporal arteritis. Occasionally it is necessary to do other tests to rule out thyroid or kidney disease.
The electroencephalogram, or EEG is not usually helpful in diagnosing what category a headache falls into, but it is valuable in the assessment of seizures, or fits, or of unconscious patients.
CT and MRI scans of the brain are particularly useful in the assessment of so-called structural causes of headache such as sub-arachnoid haemorrhage, idiopathic intracranial hypertension and brain tumours. It should be stressed that the vast majority of scans prove to be normal, and that there are some serious causes of headache (most notably temporal arteritis) which need specific treatment and yet do not show up on a scan.
Examination of the cerebrospinal fluid (CSF) by carrying out a lumbar puncture is a specialist investigation, which is only undertaken in hospital, and nearly always after a scan has been performed. If a brain scan shows that there has been a sub-arachnoid haemorrhage there may be no need to carry out a lumbar puncture. However, if a haemorrhage is suspected, but this does not appear on the scan, then a lumbar puncture is the only way of finding out if the CSF is normal.
Examination of the CSF will also confirm a diagnosis of meningitis; but while this is often useful, the more serious causes of meningitis can usually be diagnosed by a blood test, and it may not be necessary to examine the CSF if treatment with antibiotics has already been started. Other causes of meningitis, particularly the less serious type caused by a virus and the more slowly developing type caused by the tuberculosis bacterium, can only be confirmed by examination of the CSF.
The electroencephalogram, or EEG is not usually helpful in diagnosing what category a headache falls into, but it is valuable in the assessment of seizures, or fits, or of unconscious patients.
CT and MRI scans of the brain are particularly useful in the assessment of so-called structural causes of headache such as sub-arachnoid haemorrhage, idiopathic intracranial hypertension and brain tumours. It should be stressed that the vast majority of scans prove to be normal, and that there are some serious causes of headache (most notably temporal arteritis) which need specific treatment and yet do not show up on a scan.
Examination of the cerebrospinal fluid (CSF) by carrying out a lumbar puncture is a specialist investigation, which is only undertaken in hospital, and nearly always after a scan has been performed. If a brain scan shows that there has been a sub-arachnoid haemorrhage there may be no need to carry out a lumbar puncture. However, if a haemorrhage is suspected, but this does not appear on the scan, then a lumbar puncture is the only way of finding out if the CSF is normal.
Examination of the CSF will also confirm a diagnosis of meningitis; but while this is often useful, the more serious causes of meningitis can usually be diagnosed by a blood test, and it may not be necessary to examine the CSF if treatment with antibiotics has already been started. Other causes of meningitis, particularly the less serious type caused by a virus and the more slowly developing type caused by the tuberculosis bacterium, can only be confirmed by examination of the CSF.
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Contents
- Introduction
- Headache is a symptom
- What are the different types of headache?
- How is the diagnosis made?
- What causes headache?
- Migraine
- Tension-type headache
- Cluster headache
- What about the future?
- How is lifestyle affected?
- Conclusion
- Other organisations that may be able to help
- Your feedback on Headache
