Diagnosis

In two surveys, patients reported a delay in the diagnosis of their headaches of between one and six years. In one of the surveys, the presence of migraine-like symptoms (light and sound sensitivity and nausea) were major reasons for the frequent misdiagnosis by family doctors. About a third of the patients sought help from dentists and another third from ear-nose-throat specialists. In most of cases, patients were inappropriately treated for other headaches (including having sinus surgery).

Medical and Personal History

For an accurate diagnosis, the patient should describe the following:

• Duration and frequency of headaches.
• Recent changes in their character.
• The location of the pain.
• The type (e.g., throbbing or steady pressure).
• The intensity of the headache.
• Associated symptoms, such as visual disturbances or nausea and vomiting. (These are seen most often with migraines.)
• Behaviors during a headache.
• Snoring, sleep disturbances, and daytime sleepiness (which could relate to sleep apnea, a possible risk factor for cluster headaches.)

Headache Diary to Identify Triggers

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The patient should try to recall what seems to bring on the headache and anything that relieves it. Keeping a headache diary is a useful way to identify triggers that bring on headaches. Some tips include the following:

• Be sure to include all events preceding an attack. Often two or more triggers interact to produce a headache. Experts are investigating triggers of headaches to determine if certain ones are more likely to set off different primary headaches.
• Tracking medications is an important way of identifying so-called rebound headaches, which can arise when drugs that are taken frequently are discontinued.
• Be sure to attempt to define the intensity of the headache. It may be indicated by using a number system: