Identifying the cause of head pain may not always be a simple task for the attending doctor, especially if there is a lack of overt signs, presence of vague or unrelated symptoms and if there is no suitable record of the patient’s medical history. In this case, your doctor will assess your case and make a diagnosis based on concomitant symptoms that are present (like a headache with nausea and vomiting) in conjunction with your case history and clinical findings.
Further tests may also be required for a conclusive diagnosis and to exclude differential diagnoses that your doctor may have compiled during the evaluation.
There are some signs and symptoms that will be taken more seriously and raise concerns about possible conditions which need to be confirmed or excluded as soon as possible. These signs, symptoms and situations are considered as ‘red flags’ which may indicate serious, debilitating and life threatening causes of the head pains.
Some of these red flags include head pains with :
- High fever and accompanying neurological signs and symptoms, severe debility and/or signs of shock. This may be indicative of an infection of the brain or spinal cord, like meningitis or encephalitis. It may also indicate systemic conditions like septicemia or cancer. If weight loss is also reported over a period of time, this will raise the concern of HIV infection, cancer and giant cell arteritis.
- Eye signs and symptoms, like red eyes and especially if there is visual disturbances. This may be indicative of glaucoma, a tumor impinging on the optic nerve or poisoning.
- Sudden, severe headache that peaks rapidly, like within a few seconds, may be indicative of a subarachnoid hemorrhage. This is also known as a thunderclap headache.
- History of immunosuppression or cancer may be indicative of an infection within the brain or metastases.
- Neck stiffness and sensitivity to light which may be indicative of meningitis, brain abscess or a subarachnoid hemorrhage.
- No previous history of headaches or related pain in a person over the age of 50 years. This may be indicative of giant cell arteritis, cerebral aneurysm or cancer.
- Neurological signs and symptoms like double vision, numbness, tingling and/or weakness of certain parts of the body, confusion, difficulty concentrating, impaired memory and/or motor dysfunction. This may be due to a wide range of causes, some of which may be serious and life threatening. These include encephalitis, meningitis, tumors, increased intracranial pressure and/or hemorrhage.
If none of these red flags are present then other causes of head pain must be considered.
Tests & Investigation
After a complete physical examination, your doctor may request one or more of the following tests and investigations. The validity of requesting each type of test would depend on the differential diagnosis so that your doctor can confirm or exclude certain conditions that may be contributing to the pain.
- CBC (complete blood count), also known as a FBC (full blood count) which can be requested with or without an ESR (erythrocyte sedimentation rate). This test may be requested when an infectious cause (like meningitis) or inflammatory cause (like giant cell arteritis) is suspected. A CBC may also indicate other possible causes of the head pains which would warrant further tests and investigation.
- X-ray will be considered in emergency situations like after a car accident or fall. Ideally a CT scan would be considered but an x-ray can still be useful if there is time constraints and limited equipment or services at the specific facility.
- CT (computerized tomography) scan, also referred to as a CAT scan, where a series of x-rays provide cross sectional images and would be considered in emergency situations if the facilities are available. It may prove useful when the following conditions are suspected :
- Fracture(s) of the bone.
- Increased intracranial pressure – bleeding, swelling.
- Blood clots.
- Congestion of the paranasal sinuses.
- Infections like meningitis or encephalitis.
- MRI (magnetic resonance imaging) where a magnetic field and radio waves are used to compile detailed 3-D images of the brain, spinal cord and surrounding tissue. This may be done when the following conditions are suspected :
- Giant cell arteritis.
- Pituitary gland disorders.
- Spinal cord injuries.
- Lumbar puncture, also known as a spinal tap, where cerebrospinal fluid (CSF) is aspirated by inserting a needle between two verterbrae. The fluid is then sent for laboratory analysis. This may be done when the following conditions are suspected :
- Internal bleeding.
- Certain tumors.
- Inflammation of the brain or spinal cord.
- Tonometry test to measure the pressure within the eye (intraocular pressure) when glaucoma is suspected. There are different types of tonometry tests although all perform the same function.
- Other tests may be conducted depending on the differential diagnosis after taking the case history and physical examination. This may include blood tests, urine test, eye test to assess visual acuity and skin sensitivity tests for allergies.