- Fever or abnormalities in breathing, pulse, or
blood pressure
- Infection
- Nausea, vomiting
- Changes in personality, inappropriate behavior
- Mental confusion
- Seizures
- Loss of consciousness
- Excessive fatigue, wanting to sleep all of the
time
- High blood pressure
- Muscle weakness, numbness, or tingling
- Speech difficulties
- Balance problems, falling
- Dizziness
- Vision changes (blurry vision, double vision,
blind spots)
Neurological tests focus on ruling out diseases that might also cause
headaches, such as epilepsy, multiple sclerosis, and other cerebrovascular
diseases. A structural disorder of the central nervous system, as listed below,
might be suspected in the development of serious headaches:
- Tumor
- Abscess
- Hemorrhage (bleeding within the brain)
- Bacterial or viral meningitis (an infection or inflammation of
the membrane that covers the brain and spinal cord)
- Pseudotumor cerebri (increased intracranial pressure)
- Hydrocephalus (abnormal build-up of fluid in the brain)
- Infection of the brain
- Encephalitis (inflammation of the brain)
- Blood clots
- Head trauma
- Sinus blockage or disease
- Malformation (such as Arnold-Chiari)
- Injuries
- Infections, such as Lyme disease
- Meningitis
- Aneurysm
Psychological evaluation
An interview with a psychologist is not a routine part of a headache
evaluation, but might be done to identify stress factors triggering your
headaches. Patients are typically asked to complete computerized questionnaires
in order to provide more in-depth information.
Diagnostic tests
Additional diagnostic tests might be needed to rule out other medical
conditions. These tests are listed below. Keep in mind that laboratory tests are
not helpful in diagnosing migraine, cluster, or tension-type headaches.
- Blood chemistry and urinalysis — These tests are used to determine
other medical
conditions — including diabetes, thyroid problems and infections — that can cause
headaches.
- Computed tomography (CT scan) — This is a test during which X-rays and computers are used to produce
images of a cross-section of the body. A CT scan of the head might be recommended
if you are getting daily or almost daily headaches to help rule out other causes
of headaches.
- Magnetic resonance imaging (MRI) — This test produces
very clear pictures, or images, of the brain without the use of X-rays. MRI uses
a large magnet, radio waves, and a computer to produce these images. An MRI
provides information about the structure and biochemistry of the brain. An MRI
might be recommended if you are getting daily or almost daily headaches. It might
also be recommended if a CT scan does not show definitive results. In addition,
an MRI scan is used to evaluate certain parts of the brain that are not as
easily viewed with CT scans, such as the spine at the level of the neck and the
back portion of the brain.
- Sinus X-ray -— Although the CT scan and MRI
provide more details, your doctor might use this test if your symptoms seem to
indicate sinus problems.
- An EEG, or electroencephalogram, is not a standard part of a headache
evaluation.
- Ophthalmology evaluation —
An eye pressure test performed by an eye doctor (ophthalmologist) will rule
out glaucoma or pressure on the optic nerve as causes of headaches.
- Lumbar puncture or spinal tap —
A lumbar puncture or spinal tap is the removal of spinal fluid from the
spinal canal. This diagnostic procedure is only done to rule out
conditions that might be affecting the brain and spinal cord. This
test is used only if the symptoms warrant it, and it can cause a headache
for a few hours afterward.