What is My Headache?

The Questions Your Doctor Will Ask You

By Colleen Doherty, MD
Headaches & Migraines Expert
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Updated February 27, 2015.

Written or reviewed by a board-certified physician. SeeAbout.com'sMedical Review
Board.

Imagine a lifetime of intermittent headaches. You decide to finally see a

physician after years of taking various over-the-counter and herbal headache
relievers, seeking the advice of friends and family, and pouring over the
internet. You wonder what your doctor will ask you that you have not sought
out the answer to yourself. You decide to be prepared to tell your "headache
story" in detail, so that a proper diagnosis and treatment plan can be initiated.

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Introduction
While nearly 50% of adults worldwide have a headache disorder, many go
undiagnosed. Fortunately, criteria created by the second edition of
the International Classification of Headache Disorders (ICD-II) can help
doctors differentiate among common primary headaches (migraines, tensiontype headaches, cluster headaches) andsecondary headaches. Secondary
headaches are headaches caused by an underlying medical condition, like an
infection, or by triggers, like alcohol or medication overuse. When evaluating
your headache, your doctor will perform a detailed history and physical
examination. This is done in order to make an accurate diagnosis, as well as
to rule out headache warning signs. Let's examine the type of questions your
healthcare provider may ask you.
Headache Evaluation: History Taking
When evaluating your headache, your doctor will first likely ask you several
specific questions about your headache, in order to narrow down the
diagnosis. These questions include:

Character: How would you describe your headache?" (e.g. throbbing,

aching, burning or sharp)

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Severity: What is your pain on a scale of 1 to 10, 10 being the worst

pain of your life? "Would you describe your headache as mild, moderate, or severe?"
"Is this the worst headache of your life?"
Exacerbating or Alleviating factors: What makes the pain better or

worse?

Radiation: Does the pain radiate?

Onset: Was the onset of your head pain rapid or gradual?"

Duration: How long has the pain been going on for?" "Is the pain

constant or intermittent?
Associations: Are there other symptoms associated with your
headache?" (e.g. nausea, vomiting, visual changes)
Location: Where is the pain located?
In addition to these questions, your healthcare provider will also make note of
your personal and family medical history, any medications you are taking, and
your social habits (e.g. caffeine intake, alcohol use, smoking). Based on your
answers to the above questiona, your healthcare provider can decide whether
or not your headache is a type of primary headache disorder. Let's take a
closer look at the typical characteristics of the three most common primary
headache disorders: migraines, tension-type headaches, and cluster
headaches.
Migraines

Migraines are more than just headaches. A migraine is a common, neurologic

condition that may or may not be associated with a migraine aura, a
disturbance that classically causes visual symptoms, but also may include
other neurologic symptoms, like sensory or speech alterations.

Character: Throbbing, pulsating

Severity: Moderate or severe

Exacerbating or Alleviating factors: Bright lights or loud noises may

be exacerbating while NSAIDs, triptans and sleep are common migraine alleviators.

Radiation: Variable

Onset: Gradual (although usually not as gradual of onset as that of a

tension-type headache).

Duration: 4-72 hours

Associations: Nausea, vomiting, phonophobia, photophobia, migraine

aura (up to 1/3 of migraineurs)
Location: Unilateral (typically)
Tension-Type Headaches
Tension-type headaches are unique from migraines in that they are usually
bilateral, non-pulsating, are not exacerbated by routine physical activity and
are not associated with nausea or auras. On the other hand, migraines and
tension-type headaches can both be associated
with photophobia or phonophobia. Please note that according to the criteria
created by the second edition of the International Classification of Headache
Disorders(ICD-II), tension-type headaches can only be associated
with either photophobia orphonophobia, not both. Frequent tension-type
headaches often coexist with migraines without auras so maintaining a
headache diary is critical, as treatment for these conditions is distinct.

Character: Pressing, tightening, "rubber-band-like sensation" around

the head

Severity: Mild to moderate

Exacerbating or Alleviating factors: Usually alleviated with over-thecounter analgesics, like acetaminophen or NSAIDs. Smoking is one potential
exacerbating factor, especially for those suffering from chronic tension-type headaches.

Radiation: Variable but commonly patients describe the pain as

radiating from the back of the head into their neck muscles.

Onset: Gradual (usually a more gradual onset than that of a migraine)

Duration: Minutes to days (30 minutes to 7 days according to criteria

from the International Headache Society)

Associations: No nausea but may be associated
with either photophobia orphonophobia
Location: Bilateral
Cluster Headaches
A cluster headache, also known as a suicide headache, due to its SEVERE,
debilitating intensity, plagues men more than women. These headaches occur
in clusters or periods of time that typically last from one week to one year
followed by pain-free periods of at least one month. During an episodic cluster
headache, the sufferer can experience multiple attacks, typically up to eight
daily. Some individuals suffer from chronic cluster headaches, in which a
cluster headache period will last for more than one year without any pain-free
periods, or pain-free periods that are less than one month.

Character: Sharp, burning, piercing

Severity: Severe to very severe

Exacerbating or Alleviating factors: Alcohol, histamine and

nitroglycerin are examples of exacerbating factors, especially in chronic cluster
headaches. Triptans and oxygen are potential acute therapies for cluster headaches.

Radiation: Variable

Onset: Rapid

Duration: If untreated, lasts 15-80 minutes, according to criteria from

the International Headache Society.

Associations: Associated with autonomic symptoms including:
ipsilateral or same-sided conjunctival injection and/or eye tearing, nasal congestion
and/or discharge, eyelid swelling, forehead and facial sweating, miosis and/or ptosis,
and agitation and/or restlessness.

Location: Strictly unilateral and either orbital or supraorbital (around the

eye) or temporal.
Summary
When assessing your headache disorder, your doctor will likely ask you
several of the above questions in order to best understand your symptoms. It
may be a good idea to even write down answers prior to your visit, so you are
best prepared. Additionally, other tools your doctor may use in diagnosing your
headache include the POUND mnemonic or the ID Migraine Questionnaire.
Try to be thorough and proactive when evaluating your own headaches, so
that together you and your doctor can create an effective treatment plan.