DEAR DOCTOR K: I've made an appointment to see a doctor because of my frequent headaches. What is likely to happen at the appointment?
DEAR READER:
If your headaches are severe, occur often, or are unresponsive to non-prescription pain relievers, it makes sense to see your doctor. He or she will try to determine the causes of your headaches and design a treatment plan.Your appointment is likely to begin with a series of questions about your headaches. If you think about your answers to these questions in advance of the visit, it will help both you and your doctor.
For example:
- When did your headaches begin? At what age?
- Does anything seem to trigger the headaches: particular foods, particular odours, stress, particular times of the day or the week?
- How often do they occur?
- How long do they last?
- Where is the pain located when the headache starts? Does the pain travel to other parts of the head as the headache takes hold?
- How severe is the pain?
- Describe how the pain feels -- sharp, dull, constant, throbbing?
- Do you notice any other symptoms before or during the headaches, particularly trouble with your vision or an upset stomach?
- Does anything ease the pain?
Your doctor will also want to know about any medications you currently take, and whether other family members have problem headaches.
It can be difficult to recall all of these details during an appointment. That's why it's a good idea to keep a headache diary for several weeks leading up to your appointment. This is a good place to note the frequency, duration, intensity and other characteristics of your headaches.
The doctor will also perform a physical exam. This will include a blood pressure check and a careful look inside your eyes. Increased pressure in the head can be a sign of a brain tumour. This can cause swelling of the optic nerve, and the eye exam can reveal such swelling. Tension headaches can cause spasms in the neck and shoulder muscles and tender areas at the back of the head. Your doctor will check for these.
Most people do not need additional testing. No tests are needed for obvious tension or migraine headaches, for example. But if your headaches have gotten worse, or if you have pain that occurs consistently in the same location -- which could result from an underlying medical condition -- your doctor may order additional tests.
To exclude more serious causes, your doctor may perform a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These procedures let your doctor get a good look at your brain. But rest assured, the vast majority of headaches do not have serious causes.Universal Features Syndicate
Dr Anthony L. Komaroff is a physician and professor at Harvard Medical School.
