Should I see a doctor?
People often worry that their headache is due to a serious medical condition (for example, a brain tumour or meningitis). Fortunately, headache is rarely a sign of more serious illness. Read the ‘red flag’ situations that may mean you should see your doctor.
If you are worried about your headaches, make an appointment to see your doctor.
There are no diagnostic tests for primary headaches. The best way your doctor can help you get an accurate diagnosis is by taking a detailed history. This may not always be possible during your first appointment — your doctor may not have enough time, or you may be unable to recall your headaches in sufficient detail. If so, your doctor may ask you to complete a headache diary for four weeks before your next appointment.
Your doctor should also perform a physical examination, looking for neurological (nerve) signs that may suggest another cause for your headache. They may also check your eyes and blood pressure (although high blood pressure is rarely a cause of headache) and examine your head and neck for muscle tenderness and stiffness.
Scans such as computed tomography (CT) or magnetic resonance imaging (MRI) are only ever recommended by a doctor when there is reason to think a headache may be due to another (secondary) cause. These scans can be inconvenient and expensive, rarely provide any useful information and (in the case of CT scans) expose people to radiation. In most situations the benefits do not outweigh the risks.
‘Red flags’ for headache
If your headache, or the headache of someone you care about, fits any of the descriptions below, seek medical attention promptly.
A ‘different’ type of headache that has not been experienced before in someone who:
- is over 50 years of age
- is pregnant or has just had a baby
- is young and obese
- is taking warfarin or any medicine designed to prevent blood clotting
- has a previous history of cancer or a suppressed immune system (e.g. HIV/AIDS).
Headache with the any of the associated features:
- confusion with drowsiness and/or vomiting (note that vomiting can be a normal symptom of migraine too)
- seizures (fits) or personality changes
- mild stroke-like symptoms (e.g. weakness on one side of the body, slurred speech)
- fever and/or neck stiffness
- intense pain with sudden (within 5 minutes) onset
- pain so severe it wakes a person from their sleep
- pain that is progressively worsening
- persistent morning headache with nausea
- following a head injury, particularly if there was loss of consciousness
- provoked by physical exertion, coughing, laughing, straining, or sexual activity
- aggravated by a change in posture (e.g. stooping).
Potential costs and risks of CT scans
Computed tomography (CT) scans are a form of imaging that provides useful information in many situations. However, there are costs and risks associated with having a scan. Some of the costs may include out-of-pocket expenses to you. Some of the risks may include risks of the scan itself (e.g. exposure to radiation). The radiation dose varies depending on the type of imaging you have, but the more radiation you are exposed to over your lifetime the greater the risk. CT scans deliver around 37 times more radiation than a normal X-ray. Your health professional can discuss the risks and benefits of a scan for you.
- National Prescribing Service Limited. Headache. NPS News 79. Sydney: NPS, 2012. www.nps.org.au/health_professionals/publications/nps_news/current/headache_diagnosing_preventing (accessed 17 July 2012)
- British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. www.bash.org.uk (accessed 13 December 2011)