The doctor will ask about your symptoms and medical history, and perform a physical exam. The cause of a headache can be difficult to determine. The doctor will ask about the frequency and pattern of your headaches. To help provide answers, keep a diary of:

    
  • When your headaches start and end
  • What you were doing at the time
  • What you did to try to relieve pain and how effective the treatment was
  • Family members with the same condition
  • Triggers that you are aware of
  • Where the pain is located and where it spreads to
  • Other symptoms associated with the pain
  • Tests to determine the cause of headaches include:

        
  • Neurological exam—The doctor may perform a neurological exam to assess:     
  • Muscle strength
  • Coordination
  • Reflexes
  • Sensation
  • Mental status
  • Cranial nerve function
  • Blood tests—Blood tests may be done to exclude other causes of your headache. These include blood sugar , a complete blood count looking for anemia or infection, as well as other studies to potentially look for evidence of inflammation.
  • X-rays —X-rays of the neck may help determine if arthritis is contributing to a tension headache. Skull x-rays may be taken to check for structural changes responsible for sinusitis .
  • CT scan —This is a type of x-ray that uses a computer to make pictures of structures inside the head. A CT scan is used to check for conditions that may cause headaches or to determine if a structural problem is causing chronic sinusitis.
  • MRI scan —This is a test that uses magnetic waves to make pictures of structures inside the head. An MRI scan can be used to check for any conditions ( tumor or bleeding in head) that may be responsible for your headaches.
  • Nasal endoscopy—The doctor uses a thin, lighted tube to look inside your nose and possibly take samples of drainage to be tested for allergies or infection.
  • Lumbar puncture (LP, spinal tap)—During this procedure, spinal fluid is collected to look for bleeding, infections, or cancer. The opening pressure may also be measured.
  • Often, tests are done to rule out causes of your headaches.