Medical History and Physical Exam
Your doctor will want to quickly establish whether your headaches have a primary or secondary cause by reviewing your medical history and conducting a full physical examination. Secondary headaches are headaches that are symptomatic of another medical condition. Headaches that have a sudden and severe onset can indicate a serious medical condition, such as stroke or meningitis, so establishing the nature of this type of head pain is critical. Migraines are a primary type of headache.
By reviewing and updating your medical history, your doctor may be able to determine if any preexisting medical conditions or current medications could be at the root of your headaches. Your doctor will also ask you about any history of headaches in your family.
If you're brand new to a physician's practice, you should arrange to have your previous medical records and any lab or radiological test results sent over prior to your visit. If they aren't available, your provider should take a full medical history at your first appointment.
Your doctor will probably start with an assessment of the reason you're there — your headaches. She will want to know about the location, severity, frequency, and nature of the head pain, and any other symptoms that occur along with it, such as visual changes or nausea. She will also ask about what makes the pain lessen, what makes it feel worse, whether you have tried medication and comfort measures like compresses, and how successful they've been.
It's also important for your doctor to evaluate what impact your headaches are having on your everyday functioning, quality of life, and emotional well-being. This is where your headache diary comes in handy.
Your medical history should include documentation of any serious past illnesses, infections, allergies, and surgeries, and it should also note family history of any disease. If other doctors are prescribing medications for you, make sure you bring a list of them to your appointment. Try to be precise about the names and dosage of any medication you are taking now and for any medication you have previously taken for your headaches. Your provider will inquire about lifestyle issues that could have an impact on your health, including smoking, sleep and nutrition habits, alcohol and caffeine use, sexual history, sources of stress, and exercise routine.
Approximately 67 percent of neurologists have had at least one migraine in their lifetime, and 50 percent are current migraine sufferers. Compare that to a 12 percent lifetime prevalence seen in the general population. Sympathy pains? No. It's more likely this phenomenon is because neurologists are more aware of the symptoms of migraine.
A full physical examination is also key in establishing the cause and nature of your headaches. It can also reveal underlying causes for secondary head pain. In addition to taking your vital signs (i.e., blood pressure, temperature, pulse rate, and respiratory rate), your doctor will listen to your heart and lungs, examine your skin and extremities, and check for any neck stiffness.
She will also conduct a head, eyes, ears, nose, and throat examination (called HEENT in medical shorthand) to establish whether your head pain is caused by a sinus problem. Last but not least is the neurological evaluation, a key part of any physical exam involving headache.