How Are Headaches Diagnosed?

Published on January 30, 2023

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Headaches—or pain or discomfort in the face or head—are common, but debilitating conditions that most people experience. There are three types of primary headaches: migraine, tension, and cluster. You might also have a secondary headache, which is a headache that is a symptom of another underlying condition, such as a sinus infection or head injury.

When headaches become severe or interrupt your daily life, it’s good practice to see your healthcare provider to get tested and learn about treatment options that can improve your symptoms. During your appointment, your healthcare provider will usually learn about your medical history, perform a physical exam, and order lab tests or imaging tests, if necessary.

young woman explaining her headache to female doctor — SDI Productions / Getty Images

Medical History Assessment and Physical Exam

Your healthcare provider will usually start your appointment with a medical history intake. They may request you to fill out a written questionnaire or ask you questions verbally. The medical history intake helps them learn more information about your personal and family medical history and your current concerns or symptoms.

To get a better understanding of your personal history and family history, your provider may ask you:

Does anyone in your family experience headaches or have a history of migraine?
When did you first start having headaches?
Have you ever had an injury or illness that could have caused trauma to your head or brain?
Are you taking any medications?

Your provider may also you several questions about your symptoms, including:

What symptoms are you experiencing?
Where are you having pain?
How long have you had symptoms?
What does your headache feel like?
How severe is your pain?
Is there anything that might have triggered your symptoms?
Has your pain remained consistent? Or are you experiencing episodes that come and go?

It is also common for your provider to learn about your lifestyle. They could ask you questions such as:

How many hours of sleep are you getting each night?
What do you eat in a day?
Have you skipped any meals recently?
How much time do you spend on your phone, computer, or TV?
Do you smoke or drink alcohol?
Do you drink coffee or other caffeinated beverages?

After learning more about your medical history, lifestyle, and symptoms, your provider will perform a physical exam. During this exam, your provider will likely:

Measure your vital signs (e.g., temperature, blood pressure, heart rate)
Check your head or face for signs of swelling, bruising, or pain
Take a look at your eyes for redness, infection, or light sensitivity
Examine your neck, shoulders, and spine for stiffness or aches

Laboratory and Blood Tests

There are no specific labs or blood tests that can diagnose you with headaches. However, it is standard practice for most healthcare providers to order a urine and blood test to check for any general health concerns.

Your provider might also use the results from these tests to rule out any other related conditions that might be contributing to a secondary headache—such as a sinus infection, virus, diabetes, anemia, or dehydration.

In some cases, your provider may also order a C-reactive protein test, a test that checks for inflammation in your brain and body.

Imaging Tests

Your healthcare provider may order imaging tests if they have concerns about your symptoms or suspect an issue with your brain structure. While imaging tests are not common practice for a headache diagnosis, your provider may err on the side of caution during your diagnostic process—especially if you are experiencing severe or frequent headaches.

If needed, your provider may ask you to undergo one of these imaging tests:

Computed tomography (CT) scan: Uses several X-rays to create images of your brain
Magnetic resonance imaging (MRI): A type of imaging test that produces detailed pictures of the internal structure of your brain

Diagnostic Criteria

The Classification Committee of The International Headache Society has developed diagnostic criteria for each different type of headache. Your healthcare provider will determine the type of headache you have based on a variety of factors including: symptoms, severity, duration, and location of your pain.

	Migraine	Tension Headache	Cluster Headache
Type of pain	Pulsing or throbbing pain	Dull aches, tightness around your head	Sharp, stabbing pain
Severity	Moderate to severe pain	Mild to moderate pain	Severe pain
Duration	4 to 72 hours	30 minutes to 7 days	15 minutes to 3 hours
Location of pain	One side of your head	Both sides of your head	One side of your head and your eye (on the same side of the head)
Onset of symptoms	Symptoms develop gradually (usually over the period of 24 to 48 hours)	Symptoms develop gradually	Symptoms occur suddenly
Accompanying symptoms	Light sensitivity, noise sensitivity, nausea, seeing bright lights or zig-zag lines (a phenomenon known as aura)	Neck and shoulder pain, difficulty sleeping	Drooping eyelid, tears, eye redness, stuffy nose, sweating

A Quick Review

Most people have experienced at least one headache in their life. Still, symptoms can be frustrating or debilitating. If you begin to experience severe pain or headache symptoms that interrupt your daily life, it’s a good idea to visit your healthcare provider.

Your provider will ask you about your personal and family medical history, lifestyle, and symptoms. They will also perform a physical exam and order any additional lab, blood, or imaging tests if necessary.

Getting a diagnosis for headaches is important because it can help you and your provider figure out how to move forward with treatment and find ways to reduce your symptoms.

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