The Office Visit - Evaluating Your Headache: Headaches Migraines

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The office visit

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Your physician will try to determine the causes of your headaches and design a treatment plan. He or she will take a medical history and perform a physical examination. Expect some detailed questions about your headaches (see "What your doctor will want to know") and possibly some basic laboratory tests.

What your doctor will want to know

Because common headaches have few, if any, measurable effects on the body, tests aren't likely to turn up much in the way of helpful information. Instead, your doctor will rely on the information you provide about your pain. Before an appointment, you may find it useful to jot down the answers to these questions:

When did your headaches begin?
Does anything seem related to their onset?
How often do they occur?
How long do they last?
When do they occur?
Where is the pain located?
How severe is it?
What does it feel like?
Do you notice any other symptoms before or during the headaches?
Does anything seem to trigger or worsen the headaches?
Does anything ease the pain?
Does anyone in your family have a history of headaches?
How is your family and work life?
How have your headaches influenced your life?

The physical exam should include a blood pressure check and a careful look inside your eyes with an ophthalmoscope. Increased pressure in the head, which can be a sign of a brain tumor, can cause swelling of the optic disc; the ophthalmoscope examination can reveal such swelling. In some people, tension and migraine headaches produce telltale signs such as spasms in the neck and shoulder muscles and tender areas — known as "trigger spots" — at the back of the head; your doctor may check for these. But in most people who have tension or migraine headaches, the physical examination doesn't turn up anything unusual.

That's why an accurate, detailed description of your symptoms is invaluable to your physician. Describe when your headaches began; what they feel like; particular situations that seem to prompt or worsen them; and the location, frequency, intensity, and duration of the pain. It's also worthwhile to keep a log of your headaches (see "Headache diary").

Your physician will also want to know about other symptoms linked to your headaches, what's helped relieve your pain in the past, which OTC and prescription medications you currently take, and whether other family members have problem headaches. A broad discussion about your life, focusing on stresses at home or work and the impact of your headaches, can also help your doctor reach the correct diagnosis and plan the best treatment.

Anyone over age 40 who's bothered by headaches should also schedule an appointment with an ophthalmologist to check for glaucoma. This condition, which involves elevated pressure in the eye, can cause headache-like pain. It's treatable but can lead to blindness if it goes undetected. Because eyestrain from squinting can cause headaches, a thorough eye exam may also reveal that something as simple as getting new glasses might alleviate your pain.

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Last updated:	September 05, 2008

Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.

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