Background
Headaches are diagnosed largely from their pattern: how often they come, how long they last, what they feel like, and what surrounds them. That pattern is very hard to reconstruct from memory in a ten-minute appointment. A few weeks of brief notes usually shortens the path to an accurate answer more than any single conversation can.
Key points
- Headaches are diagnosed mainly from their pattern over time.
- A short written diary is more reliable than recall.
- Frequent painkiller use can itself sustain headaches.
What to look out for
- A sudden, severe headache reaching peak intensity in seconds
- Headache with fever, neck stiffness or a rash
- New weakness, numbness, confusion or visual loss
- Headache after a head injury
- A clear change in a long-standing headache pattern
At a glance
What this means in practice
Headache days per month is the measure most treatment decisions are built on.
Nausea and sensitivity to light or sound help separate migraine from tension-type headache.
Using acute painkillers on many days each month can itself perpetuate headaches.
Sleep, meals, stress and menstrual timing are the patterns most often missed by recall alone.
A thunderclap onset, fever with neck stiffness or new neurological symptoms need urgent assessment.
Evidence summary
Headache guidance recommends diagnosis based on a structured history and a headache diary, and specifically warns that regular use of acute pain medication on ten to fifteen or more days per month can lead to medication-overuse headache.
References
- National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. NICE guideline CG150.
- International Headache Society. International Classification of Headache Disorders, 3rd edition.
- World Health Organization. Headache disorders fact sheet.