Diagnosis

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Because migraine headaches are believed to have a genetic component, it's important that your health care practitioner review your family history. Even if you are not aware that a relative suffered from migraines, consider information you may know about, such as past illnesses and lifestyles. Keep in mind that the term "migraine" was not used much until the 1950s, and even then many migraines were not diagnosed or referred to as "migraines."

When checking family history, ask these questions:

• When growing up, do you recall a family member who was sick much of the time?

• If so, did he/she exhibit any of the following symptoms: head pain that interfered with daily activities, nausea or vomiting, sensitivity to light or sound, numbness or speech difficulty?

• To what did he or she attribute symptoms of their headache: menstrual cycle, over-work, fatigue, stress or something eaten or drunk?

Be prepared to discuss with your health care professional both the symptoms of relatives' headaches and their methods for coping.

Diagnosing a headache relies on ruling out other problems, such as tumors or strokes. Experts agree that a detailed question-and-answer session can often produce enough information for a diagnosis. Some women have headaches that fall into an easily recognizable pattern, while others require further testing to determine if symptoms are due to secondary causes such as dental pain, hemorrhage or tumor.

You may be asked:

• How often do you have headaches?

• Where is the pain?

• How long do the headaches last?

• When did you first develop headaches?

Your sleep habits and family and work situations may also be discussed.

Most of the time, a migraine diagnosis is made by focusing on your history, inquiring about past head trauma or surgery and about the use of medications. However, health professionals may also order a blood test to screen for thyroid disease, anemia or infections that might cause a headache. In addition, they may take x-rays to rule out the possibility of a brain tumor or blood clot.

Other tests that may be ordered to rule out other medical problems include:

• An electroencephalogram (EEG) to measure brain activity. An EEG can indicate a malfunction in the brain, but cannot usually pinpoint a problem that might cause a headache.

• A computed tomographic (CT) scan. The CT scan produces images of the brain that show variations in the density of different types of tissue. The scan enables the physician to distinguish, for example, between a bleeding blood vessel in the brain and a brain tumor. The CT scan is an important diagnostic tool in cases of headache associated with brain lesions or other serious disease. Experts generally agree, however, that this sophisticated and expensive technology is not required to diagnose simple or periodic headache.

• An MRI scan. Today, MRI is the preferred tool to rule out headaches associated with aneurysms and brain lesions. MRI scans provide a more detailed view of the cerebral anatomy and are warranted in cases where migraine is not definitively ascertained by history alone.

• An eye exam, to check for weakness in the eye muscle or unequal pupil size. Both symptoms are evidence of an aneurysm—an abnormal ballooning of a blood vessel. A physician who suspects that a headache patient has an aneurysm may also order an angiogram. In this test, a special fluid that can be seen on an x-ray is injected into the patient and carried in the bloodstream to the brain to reveal any abnormalities in the blood vessels.

A lumbar puncture (spinal tap), to rule out meningitis or encephalitis if the headache is associated with neck pain, fever and/or sudden onset. The spinal tap takes about 30 minutes and may cause a headache due to the drop in cerebral spinal fluid pressure. There is also a small risk of infection with this procedure.

Your health care professional will analyze the results of all these diagnostic tests along with your medical history to make a diagnosis.

Head pain is typically diagnosed as one of the following types of headaches; some people have more than one type:

• Migrainous headaches, the group that includes migraine; this type of headache is caused is recognized as being principally "neurogenic," or of neurological basis, rather than "vasculogenic," or related to blood vessels, as was once thought.

• Tension-type headache. These headaches involve the tightening or tensing of facial and neck muscles.

• Cluster headaches. These involve excruciating pain in one part of the head and are rare. They are most commonly found in men with associated eye tearing and nasal congestion on the side of the head pain.

• Traction and inflammatory headaches: Also rare, these headaches involve symptoms caused by other disorders, ranging from stroke to sinus infection to an abnormal growth or mass.