Men that look no further than their outsides, think health an appurtenance unto life, and quarrel with their constitutions for being sick; but I that have examined the parts of man, and know upon what tender filaments that fabric hangs, do wonder that we are not always so; and considering the thousand doors that lead to death, do thank my God that we can die but once. Thomas Browne
Headaches - Diagnosing Headaches
Just about everyone has suffered from a headache during their life. Since we have all experienced the pain of a headache, diagnosing a headache may seem like a simple task. You might be surprised to find out however that it can be more difficult than you would think.
Physicians have no general and definitive set of tests for diagnosing headaches. If you feel it, you feel it. But no one else can literally and directly feel your pain, so doctors have to rely on what you report. And, when it comes to reporting symptoms, descriptions can vary wildly.
Some people simply aren't as articulate as others in describing what they feel. The vocabulary for describing it is lacking to an extent as well. Calling a feeling a 'stabbing pain' is (literally speaking) just a metaphor. In many cases, the pain is diffuse, making it difficult to report even the location accurately.
Another difficulty in diagnosis lies in the fact that headaches are not all of one type.
Simple tension headaches - produced by inflamed neck or facial muscles, constricted head blood vessels and other causes - don't generally get diagnosed professionally at all. They're treated with analgesics or just endured until they fade. Migraines, on the other hand, are more intense and periodic. Even here almost half of migraine sufferers never see a physician for their condition.
Physicians can use some objective factors in diagnosing the type of headache, in order to recommend a reasonable treatment.
Even though the pain is subjective, the type of pain is indicative of the type of headache. Migraines, for example, often produce intense throbbing or pulsating sensations. Ordinary tension headaches are typically more regular and diffuse.
Migraine headaches are often accompanied by nausea and vomiting, sensitivity to light and sound, cold extremities and other signs that those afflicted recognize. Since they tend to be roughly the same from one person to another, that forms an objective group of symptoms that professionals can rely on to form a proper diagnosis.
Cluster headaches are intense pain behind the eye, or temple, that occur for short periods (30 min to 1.5 hours, typically), then re-occur the next day around the same time. This can go on for weeks. Since it's fairly regular, here again physicians have something to go on.
In cases where the headache is the effect of some serious underlying neurologic or other condition, such as a brain tumor, physicians can look for those factors when headaches are reported.
CT or MRI scans can be used to look for well-documented brain activity patterns that can correlate the headache to the underlying physical problem. Headaches that progressively worsen provide doctors an additional clue. Patterns which shift rapidly are another. In some cases an aneurysm (weakening of a blood vessel) that is the root cause can be detected this way.
In those cases where the headache is the result of incorrect medication use - MOH (medication overuse headache) - physicians have the history of the medication used to assist their diagnoses. Medical history of another sort is helpful, too. Migraines run in families, while cluster headaches do not.
Diagnosing headaches is a difficult process. The variety of types and multitude of symptoms create a complex set of factors that make it challenging to diagnose. Obtaining as much information from the patient and tests is the best way to properly diagnose the headache.
Fortunately, they are rarely severe enough to cause vomiting or excessive sensitivity to light and sound, as migraines can.
Triptans, introduced in the 1990s, come in a variety of commercial types and names, such as sumatriptan (Imitrex) and others. In practice, the pain can be nearly anywhere above the neck, but is typically more localized. Contemporary research suspects the interaction of serotonin (a neurotransmitter) with nerve cells is responsible, but no one knows for sure.
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