Diagnosing Headache in Adults
Most people experience headache pain every now and then. Many headaches are simply a nuisance and can be relieved using over-the-counter medication. If your headaches become severe, NYU Langone doctors can provide you with the best and most effective treatment plan.
Headaches are divided into two categories: primary and secondary. Primary headaches are not caused by an underlying health condition or structural problems in the brain, head, or neck.
Secondary headaches are more rare and are caused by an injury or a condition. Underlying conditions may include meningitis, which is a bacterial infection of the membranes covering the brain or spinal cord, or an aneurysm, which occurs when the wall of a blood vessel weakens and widens, potentially bursting.
Primary headaches are classified as episodic when they occur fewer than 15 days per month. These headaches are considered to be chronic when they occur more than 15 days per month over a 3-month time span.
Types of Headache
The three major types of primary headaches are tension-type, migraine, and cluster headaches. All three cause pain, although the type and severity of this pain varies.
Tension-type headaches may cause dull pressure or constant, tight, vise-like sensations in the head, scalp, or neck. Pain is usually mild to moderate and is distributed equally around the head.
These headaches can be triggered by stress, lack of sleep, hunger, or activities that require staying in one position for too long, such as using a computer or reading.
Tension-type headaches are the most common kind of headache and are slightly more prevalent in women than in men. They are often episodic but can evolve into a chronic condition.
Migraines are debilitating, recurrent headaches that cause moderate to severe throbbing pain on one or both sides of the head. Migraines can be chronic, meaning they occur 15 or more days per month over a 3-month time span, or episodic, meaning they occur fewer than 15 days per month.
Visual or sensory symptoms often accompany migraines, causing sensitivity to light and sound as well as nausea or vomiting. During a migraine, people may also experience trouble speaking, dizziness, numbness, confusion, or other symptoms similar to those of a stroke.
Migraine pain typically builds up for a few hours and may intensify with movement or physical activity. Migraines can last anywhere from four hours to several days if not treated.
People who experience migraines tend to have recurring attacks that can be triggered by a variety of factors, such as anxiety, stress, hormonal changes, bright or flashing lights, and certain foods or drinks.
Cluster headaches cause severe, stabbing pain located around one eye or in the temples. These episodic headaches commonly happen around the same time every day, often near bedtime or after you go to sleep.
They may occur for several weeks or months at a time. People who experience one of these headache episodes may not have symptoms again for several months or even years.
This type of headache tends to pass more quickly, but is more intense, than a migraine. Cluster headaches are less common than tension-type headaches and migraines.
They may cause redness and tearing of one eye, nasal congestion, or a droopy eyelid, and the pupil may change size. Cluster headaches occur more frequently in men and young adults.
Diagnostic Tests for Headache
Relying on over-the-counter pain medication to treat chronic headaches can lead to overuse of these medications, which, over time, can make headaches worse and unresponsive to treatment, even when the medications are used as directed. The doctors at NYU Langone can help to ensure you are not experiencing headaches from medication overuse.
To determine the type of headache causing your pain, neurologists at NYU Langone ask about your symptoms, focusing on the frequency, intensity, duration, location, and any known triggers. Your doctor also asks about your medical history and performs a physical exam to obtain a complete picture of your health.
A careful review of your symptoms can help your doctor to determine the type of headache and if an underlying condition could be the cause. Your doctor may use one or more of the following tests to arrive at the most accurate diagnosis.
A neurological examination may include an evaluation of your mental status, motor strength, vision, and reflex testing. Your doctor may also assess the function of the nerves connected to the brainstem—the cranial nerves—by testing for sensation in the face, checking your hearing and eye movements, asking you to swallow or say “ahh,” and observing your ability to move your head, neck, and shoulders.
Your doctor may test your vision and look for any signs of increased pressure in your head. Your reflexes may also be checked to see whether the headaches are caused by a rarer problem, such as a brain tumor or blood clot in the brain, or to rule out the possibility that another condition may be causing your symptoms.
MRI uses magnetic waves and computers to create two- or three-dimensional images. Your doctor may order an MRI scan to view the inside of the head and neck. This can reveal the presence of other conditions that can cause headaches, such as a tumor or abscess, which is a collection of pus that has formed in response to an infection.
Sometimes, MRI scans of the neck are used to identify problems with the cervical spine—the bones in the neck—that may be triggering headaches.
Magnetic Resonance Angiogram
A magnetic resonance angiogram, or MRA, is similar to an MRI scan. It’s an imaging technique that is used to check for an abnormality, such as an aneurysm, in the blood vessels of the brain.
The test may involve injecting dye into a blood vessel, so that your doctor can view blood flow in the arteries or veins of the head or neck. Some MRA scans can be done without the use of dye.
MRA scans allow your doctor to see if blood vessels are blocked by a clot or if there are any other factors that may be restricting or increasing blood flow and triggering the headaches.
NYU Langone specialists use the results of these tests, along with their clinical judgment and skills, to craft a treatment plan to alleviate your symptoms. If your doctor determines that your headaches are caused by a secondary condition, he or she may recommend that the underlying condition be treated first to see if this stops the headaches from occurring.