Diagnosis

When you see a healthcare professional about your headaches, they should ask you to describe the headaches and any other symptoms you have. This is to check whether another health problem is causing your headaches. If your healthcare professional thinks your headaches might be secondary headaches they may refer you for tests or to see a specialist. They may do this if you have any of the following.

  • An injury to your head that happened within the past 3 months.

  • Headaches that are getting worse and that are accompanied by a fever.

  • Headaches that start very suddenly.

  • Problems with speech or balance that happen regularly and are getting worse.

  • Problems with memory or changes in your behaviour that happen regularly and are getting worse.

  • Feeling confused or disoriented.

  • A change in your personality.

  • Headaches that start after you have coughed or sneezed, or have been straining.

  • Headaches that start after you have been exercising.

  • Headaches that are worse when you are sitting or standing up.

  • A red or painful eye.

  • A substantial change in your headache symptoms.

You may also be referred for tests or to a specialist if you have never had the headaches before and you have any of the following:

  • Your immunity is low, for example because you are HIV positive or are taking drugs that lower immunity.

  • You are aged under 20 and have had any type of cancer.

  • You have had a type of cancer that can spread to the brain.

  • You are vomiting for no obvious reason.

Keeping a headache diary

Your healthcare professional may ask you to keep a headache diary to help diagnose what kind of headache you have. They should ask you to keep your headache diary for at least 8 weeks. Your headache diary should record the following.

  • How often you get the headache, how long it lasts and how painful it is.

  • Any other symptoms you have before, during or after your headache.

  • What medications you took for your headache.

  • Anything you think might have triggered your headache.

  • If you are a woman or girl aged 12 or over, whether your headache happens around the time of menstruation.

You may also be asked to keep a headache diary after you start treatment for your headache. This helps you to keep track of whether and how well your treatment is working. It also helps you to remember details about your headache so that you can discuss it with your healthcare professional.

Common headache symptoms

Where is the headache?

What does it feel like?

How painful is it?

How long does it last?

Does it stop you from doing any of your usual activities, such as going to work or school?

What kind of headache is this?

Both sides of your head, face or neck.

Something is pressing or being tightened around your head.

Fairly painful.

At least 30 minutes.

No.

Tension‑type headache

Either one or both sides of your head, face or neck.

Something is pulsating, throbbing or banging in your head.

You are unusually sensitive to bright lights or loud sounds.

You may feel sick or vomit.

Very painful.

At least 4 hours (or at least 1 hour if you are aged 17 or younger) and up to 3 days.

Yes.

Migraine 1

One side of your head or face and around or above one of your eyes.

The pain can be sharp, burning, throbbing or tightening, or feel as if something is being tightened around your head or drilling into your head.

You feel restless or agitated.

Your forehead or face is sweaty.

Your nose is blocked or running.

Your eye on the side where you have the headache is red or watering, and the eyelid may be swollen or drooping.

Extremely painful.

At least 15 minutes and up to 3 hours. You have this headache at least every other day for at least 2 weeks.

Yes.

Cluster headache

1See other NICE guidance for details of our guidance on preventing headaches in adults with chronic migraine.

Migraine with aura

Some people with migraine have symptoms called 'auras'. The auras can either happen on their own, without a migraine headache, or together with a migraine headache. Common symptoms of an aura are:

  • problems with sight such as seeing flickering lights, spots or lines, or a loss of vision

  • pins and needles or numbness

  • problems speaking.

Auras are temporary. They take at least 5 minutes to develop, and last for between 5 minutes and 1 hour. If you have any common aura symptoms your healthcare professional should diagnose migraine with aura, even if you don't have a headache.

If you have less common aura symptoms, for example temporary muscle weakness, poor balance or feeling confused or disoriented, your healthcare professional may refer you for tests or to a neurologist or a GP with a special interest in headaches.

Menstrual-related migraine

If you are a woman or girl aged 12 or over with migraine that usually happens around your period (from 2 days before to 3 days after your period starts), you should be asked to keep a headache diary for at least the next 2 periods. If you have migraine during any of the 5 days around your next 2 out of 3 periods, your healthcare professional should diagnose menstrual‑related migraine.

There is more information about migraine in women aged 12 or over in special considerations for women and girls with migraine.

Medication overuse headache

If you often take painkillers, NSAIDs, triptans or ergots for headaches, and your headaches become more frequent or worse, your healthcare professional should consider whether you have medication overuse headache. Medication overuse headache is especially common in people with migraine. The causes of medication overuse headache are not known.

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