Diagnosing headache

Headache is common. There are many different types of headache. Accurately diagnosing headache depends on a detailed history and a targeted examination.

  • Distinguish between primary and secondary headaches when establishing an accurate diagnosis.1
  • Take a comprehensive history, and perform careful, targeted physical and neurological examinations.1
  • 'Red flag' symptoms and signs indicate the need for investigation, such as neuroimaging.

Refer to the diagnostic criteria for the three most common types of primary headache: episodic tension-type, migraine and cluster.2 People often experience episodes of both tension-type and migraine headaches. There are no diagnostic tests for primary headache. Most are benign and investigations are not usually needed.

Neuroimaging is not needed for people with a normal neurological examination and without any red-flag symptoms.

Know and look for red flags when diagnosing headaches

Consider secondary headache in anyone with new onset acute headache, or a headache that is different from their usual headache.1 Red-flag symptoms and signs together with an abnormal neurological examination indicate the need for specialist referral for further investigation, such as neuroimaging.1


  1. British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type headache, cluster headache and medication overuse headache. Hull: 2010. (accessed 21 June 2012).
  2. Rossi S, ed. eAMH [online]. Australian Medicines Handbook 2010. Adelaide: Australian Medicines Handbook, January 2010.